Laserfiche WebLink
I. Tbat,,Wshe b"read aH file provisions ofthis�and that the description inakided 1gf�.R 01f am COSZCCr EO to best Of IIIS�1Cd . <br /> knowhwIM and <br /> 2. Thad he/she is The owner of the respective property,or is gwdified to represent dm owner;and <br /> 3. That he/she will assume full rrspogSWhty for all hkft for persaui injury ordamaV E0 pmpeciy which may arise out ofthe work described above, <br /> or which may arise out of Ws&w failure to do the womicp ovidedherein;and <br /> 4. That in the event any claim of auc hliability is made against%eComty of San Joaqimnoranydeparimment official err employee theaeof,he shall <br /> defend,indemnify and holftem and each of them humless for such claim;and <br /> s. That work shall be perkmed by The applicant and/or any raprese tahve of the applicant in The County Rigl*4--Way at the above indicated site <br /> with a valid San.7oagnin Comely Encroach ne. Pammit;and <br /> 6. That if peamssion is granted as regmsted,heap=to do the work described in.acoordanoe wdhall teens,000di ic:os and restridion af1his and any <br /> attached as gmaxi or spacial m pm moos. <br /> Sim ofApplicant-Tide nate <br /> FIELD INSPEMOR COMMUSM <br /> »»»»»»»»»»»»»»»»»»»EXffiTINO•CONDMON3«««««««««««««««««««« <br /> f <br /> 1. DRftWAY: None ❑ Dirt Brave/ ❑ Aggregate roue ❑ Pavea(p ) ❑ Paved( ❑ <br /> . SLOPING Awayfram Pavement ❑ Towards paves ent ❑ Flat <br /> 3. PIPES:. Now �, Exiedeg-Type <br /> Odwpipesinneigbbodwod: Yes ❑ No Appmadra Crom Drain ❑ Size <br /> Aitadnwm t to ad s pipe. Yes ❑ No <br /> a HUDWALU Yes ❑ No ❑ <br /> S.ASPIZALT CON+CBETLF DISE. Yes ❑ Na <br /> 6..BARRIERS along Rigbt-cMay w/a <br /> 1. BTl>CH Yes ❑ No Ifym:. V Style ❑ 2 Foint ❑ 9War ❑ W-W& Depth <br /> »»»»»»»»»»»»»»»a»»>»PERMITREQUIfMUNN<z««««««««««««««««««« <br /> L DR n.WAY. OR COMMERCIAL. ❑ AORtCtJ nT" ❑ INDUMIAL ❑ <br /> PAVED with 2 "W.Depth A.C,over•. 4 "Mm DV&3/4"A.B. <br /> h <br /> Notre <br /> 2. RIPE& I mpfh of Pipe Regn{rod:• Ft and Disodeter of Pipe Inch <br /> To be connected to any adjacent driveway pi" Yes ❑ No <br /> DRAHIAM INLET REQUIRED Yea O No �. <br /> Tow Iangft (wvb pr+opm* ToW N=3ber of Stm=Desire h&ft <br /> NatcB <br /> 3. HEADWALL Yes no No . <br /> +t PAVED FRONTAGE: PAVED with "Mm.DepOk AC.over "Wm.Depth 3W A.B. <br /> lrieaauing Feet in length and Feet in width <br /> FEF.$ <br /> Driveway Fnaoac.hment Permit base fee.........:.............. <br /> Feld Inspection - <br /> vewayw/arw�opipn.._..._ __ _ S9s_00 ❑Pevadt3m daga._...._.....:__ ..__ sI0000+o.46/ft <br /> Ddvewayw/box Q&at...._......._...... _.S1S5.00 ❑ Crnh,autter>Sidewallr..:.._.. .... ._SIo0.tI0+0.98/& <br /> Ceunfer\Computey c:Wcoms49pplioation for Pemrilsllhiyeway and Paved Froze Fage.2 of 2 Revised 8!2000 <br />