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--- — -- <br /> �_.,�.�---—- cox are correct to the best of his/her <br /> 1. That he/she bas read all the provisions of this�,and that the desc�ion inclosed iathis application <br /> knowhvdge;and <br /> 2. Thad helshe is the owner of the fegmctive propetty,or is qualified to rgmsmt&o owner;and <br /> y fat all y for injury or io"mqr which may arise out ofthe wodc described above, <br /> 3. That hdsre will sasume fall responsaht <br /> or which may arise out of his&er failum to do*o wodcptovided herein;and <br /> 4. That in the event any claita of W&fidmTt1Y is made against ihacemty of San]bagim or awry depeahmerrt,official or empkoyen>hxe4 he shall <br /> defead,indemnify and holdihem and each d&=harmless for such ckirn;and <br /> S. That work shall be pe formed by the applicant and/or any repment&five of tw applicant in the County Right-of-Way at the above indicated site <br /> with a valid San Joaquin County FAcroad me°t Pacmiit;and <br /> b. That if paanission is granted as re*msted,he apm to do the work described in accordance wi&all t=319,oonrmtions and r estridien ofthis and any <br /> attacbed sheet,mdudod as Wall or special III ptovrstans. <br /> Mgmdm of T� Data <br /> FIEF INSPECTOR COUMdENTS <br /> »»MaST11STC3CONDITiOiN S«««««««««««««««««««« <br /> L DR�EWAY: Nene ❑ Dict ❑ Gravel � Agg< sd-Base ❑ ��(poor) ❑ Paved(Good) ❑ <br /> 2. &LOPING: Awayfr+mrPawmant ❑ Tomudspavamant ❑ F7at <br /> 3. PIPES:. New E -Type <br /> Other pipes ianr hbodmxxt Yes ❑ No Approaches Crow Drain ❑ Size <br /> Alt ubma t to n*oboea pipe: Yes ❑ No <br /> 4. RRADWAL . Yes ❑ No' <br /> S. AWHALT CONCRM DIICL►: Yes ❑ No <br /> t~.BARRIERS along Ri&,O&Way 4 <br /> 1. DITCH Yes ❑ No IfYes:• V Style ❑ 2%int ❑ Olhw ❑ Width Dapdk <br /> PERMIT REQUIRgIAENT'S«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR COMMERCIAL ❑ GRtCUI.W& ❑ I1VDU3TBL�L <br /> � ❑ <br /> PAVED with Z "Mm.Depth A.C.over W.Depth 3/4"A B <br /> Not ea <br /> 2. PIPE& Le*h of pip*Regal' Ft and Diama6er of pipe inch <br /> To be 000nec W to any adjacent driveway pipe Yea ❑ No <br /> DRAWAOE INLET REQUIRED Yes ❑ No <br /> ToOl l moh (with proposed) Total Nwaber of Strom Dada I61e65 <br /> Nob a <br /> 3. HEADWALL Yes ❑Q No . <br /> 4. PAVED FRONTAGE: PAVED with "Mim Depth A.C.over "lain.Depth 3/4"A.R <br /> Measuring beet ion and Feet in width <br /> FEES <br /> Driveway hmmachm at Permit baso fen................_..........585.00 <br /> Field Impection <br /> ❑Driveway m/or w/o pips......._ .....395.00 ❑Paved fm(mga--....-.-..—..__....SI00.00+0.4618 <br /> ❑Driveway w/box Calvert. _...._.___.SiS5.00 ❑ Curb,Outtec,Sidewalk..:..... ... .. Si00.00+0.9878 <br /> Corruta'�Computer,c:l=mV%pplioation for P \Driveway and Paved Frontage Page.Z.of 2 Revlaed 812000 <br />