Laserfiche WebLink
'11 N;Arr_LA%..AiN1IMMLS1 1:F.1C1MLLb: <br /> 1. That he/she bas read all the provisions of this applicatiaq and that the descxilstim included Mathis amAication are coned to the best of h s/her <br /> knowlwdge;and n <br /> 2. That he/she is the owner of the respective property,or is qualified to represent the owner,and <br /> 3. That he/she will asmne full responsibility for all liabrMy forpen onai inju y or damage to property which may arise out of the work described above, <br /> or which may arise out of hk4w failure to do the warkprovided herein;and <br /> 4. That in the event any claim of such liability is made againsttheC,omty of San Joan un or any departmem,official or employee thereof he shall <br /> defend,indemnify and holdfli m and each of them harmk ss for such clans;and <br /> S. That work shall be performed by the applicant and/or any representative of the applicant in the County Right-of-Way at the above indicaled site <br /> with a valid San Joaquin Coudy Eaanadmmaot Ple mi4 and <br /> 6. That if peen ssicn is granted as requested,he agrees to do the work described in accordance withall trans,condition and restriction of this and any <br /> attached sheet,' 90x21 special III proaisioma <br /> Fine Date <br /> FIELD INSPECTOR COARMWZM <br /> EMSTMG CONDITIONS«««««««««««««««««««« <br /> L DRIVEWAY: Now Q Dittt ❑ Gravel Aggregate Baan ❑ Pa—%,00) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away1rom Pavmrent ❑ T—=&Pavement ❑ Flat JR <br /> 3. PIPES: Now [ Existing-Type <br /> 0dwrpipesinnrigl> cdwod: Yes ❑ No ® Appeadus 0 Cross Drain ❑ Size <br /> Attar ment to neigbboes pipe: Yes ❑ No [9 <br /> 4.HEADWAid.: Yes ❑ No <br /> } <br /> S.ASPIIALT CONCRETE DIICE: Yes ❑ No <br /> C.BARRMS akmg%&-&£Way <br /> 1. xnm Yes ❑ No �. IfYes: V Style ❑ 2 Point ❑ other ❑ Wi lth Depth <br /> »»»»»»»»»»»»»»»»»»PERMITREQUIREMMM<z««««««««««««««««««« <br /> 1_DRIVEWAY: SFR COM1tIERCIAL ❑ AORiCULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with 2 "Min.Depth A.G.over Mm.Depth 3/4"A.B. <br /> NOW <br /> 2. PIPE& L &*of Pipe Requkv& Ft.and Diantder of Pipe Hach <br /> To be connected to any adjacent ddveaamy pipe Yes ❑ No <br /> DRAINAGE INLET REQUIRED Yes ❑ No ®. <br /> Total Length: (with proposed) Total Nusuiluer of Storms Date Istria <br /> Notes <br /> 3. HEADWALL Yes ® No �. . <br /> 4. PAVED FRONTAGE: PAVED with "Mm.Depth A.C,over "Mm.Dapth 3/4"A.B. <br /> Mmsrrimg Fed in ked and Feet in width <br /> FEES <br /> Driveway Encroachment Permit base in................_..........$85.00 <br /> Field hupa-tion <br /> ❑Driveway w/or w/o pipe.......... _ ._ :. .._.......5995.00 ❑Paved +0.46/ft <br /> ❑Driveway w/box Cmlvart.._-----_ ._..... .. ._.._..._.._..$155.00 ❑Crib,Gutter,Sidewalk.......................$100.00+0.98/ft <br /> CcunterlCompi tar,c:1AaeaslApplioetion for ParmiWDriyeway and Paved Frontage Page.2 cf 2 Revised 8/2000 <br /> i <br />