Laserfiche WebLink
i j.-., this application are corned to the best of his/her <br /> I. That he/she hes read all the provisions of this X04,and that the descsiptioa included in <br /> lmawhvdge;and <br /> 2. 'That he/she is the owner of the respective property,or is qualified to represent thoo-Aw,and <br /> 3. That�/ will assame full respomsibrlity for all bail y Orpmwtml mjmy or damage to pro;►erly vvhichmsy arise out oftho work described above, <br /> or which my arise out ofNs/hor Mm to do the worlcprovided hmm4 and <br /> 4. That in the event any claim of such liability a made agaimt lkConmty of San jbagi or any depertmrt,official a employee&wed,he shall <br /> defend,indemnify and holdthem and each of them hmmkw for such claim;and <br /> 5.That work-ahall be pafornrod by the appliear#t and/or say rWweda&e of the applicant in the County Ri*of-Way at the above indicated site <br /> with a valid San Joaquin Couoiy Encroachment Pamsit;and <br /> b. That if permission is granted as requested,leo agrees to do the wa&dwmW in acomlanee wi$r all tennis,conditions and restrictier<af this and any <br /> attache included ass or special m <br /> t3ig ofApplicant Tille ate <br /> FIELD INSPECTOR CO11d EUM <br /> »»EXIgTMtgZON3«««««««««««««««««««« <br /> L DRIVEWAY: Ncae Dirt ❑ Gravel ❑ Aggresede Base 1 Paved(poor) ❑ P-*Good) ❑ <br /> 2. SLOPING: AwayfinmPava mg ❑ TowardsPavemect ❑ Flat <br /> 3., PIPES:. Now ( % Ensting-Tyl, _ <br /> Otherpipeginnei ood: Yes ❑ No Approaches Cross Drain ❑ Size <br /> Aftachmaot to neigbboes Yen ❑ No <br /> L HEADWALL: Yes ❑ No <br /> S.ASPIt<ALT coNcRm I)=: Yes ❑ No <br /> 6..BARRIERS alongRigbt-af•Way <br /> 4. DIPTCH Yea ❑ No TfYea:• V Style ❑ 2 Point ❑ Other ❑ Width Depdi <br /> »»>>>>> »»»»»»»»»»PF.RIMT REQUMEMMM<z««««««««««««««««««« <br /> L DRIVEWAY: SFR -- CObII1d M AL ❑ AGRiCULTUR$ ❑ INDUSTRIAL ❑ <br /> PAVED with S- »Mm.Depth A.C.ovw 1 "Mm Depth 3/4"A.B. <br /> Notes <br /> 2. PIPM LenghoMpallapko& Ft andDiaotateraFPipa --- -- Inch <br /> To be con6clad to any adjacu t drhemy.pipe Yes ❑ No IX�� <br /> DRAINAGE INLET REQUIRED Yes D No <br /> Tow Length: (wAh proposed) Total Nua hes of Storm Dra6r Witt$ <br /> Nates <br /> 3. HEADWALL Yes 0 No <br /> 4. PAYED FRONTAGE: PAVED with "hfiL Depth A.C.over "Mm Depth 3/4"AB. <br /> Measuring Fed is kft&and Fed is width <br /> FEES <br /> Driveway Facroachmant Permit base flee Wif <br /> ................_..... ... 00 <br /> Feld Impecdon <br /> Driveway w/or w/o pipe......... .. _.._ _ _$95. ❑Paved fimdge........._.........__..__....$100.40+0.46d <br /> ❑Driveway w/box Calvart._..-.................. _ __.... 155.00 ❑Curb,Clutter,Sidewalk..:.. . ...._.....5140.00+0.98/R <br /> CaunterlCmVutm;c:lAcceselAppliaation for Permid0riyeway and Paved Fiorusge Pago.2 cf 2 Revised 8/2000 <br /> A, <br />