Laserfiche WebLink
THE APPLICANT HEREBY CERTH-IL'S: that the description included in this application are correct to the best of his/her <br /> 1. That he/she has read all the provisions of this application,and <br /> knowlwdge;and <br /> 2. That he/she is the owner of the respective properly,or is qualified to represent the owner,and <br /> 3. That he/she will assume full responsibility for all liability for personal injury or damage to property which may arise out of the work described above, <br /> or which may arise out of his/her failure to do the work provided herein;and official or employee thereof he shall <br /> 4. That in the event any claim of such liability is made against the County of San Joagiun or any depart <br /> defend,indemnify and hold them and each of them harmless for such claim;and <br /> 5. That work shall be Performed by PP the applicant and/or any representative of the applicant in the County Rigbt-of-Way at the above indicated site <br /> with a valid San Joaquin County Encroachment Permit;and <br /> work in accordance with all terms conditions and restriction of this and any <br /> 6. That if permission is granted asested,he agrees to do the <br /> attached sheet,' 1 or sped ons. �z_ <br /> Data 4/C! <br /> Sr Applicant-Title <br /> FIELD INSPECTOR COMMENTS <br /> >>>> >>EXISTING CONDMONS«««««««<<<<<<««««««« <br /> i. DRIVEWAY: <br /> None Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away from Pavemant ❑ Towards Pavement E] Flat <br /> 3. PIPES: None ❑ Existing-Type <br /> Other pipes in neighborhood: <br /> Yes No ❑ Approaches ❑ Cross Drain ❑ Size /2 h <br /> Attachment to neighbor's pipe: Yes ❑ No <br /> 4. HEADWALL: Yes N No ❑ <br /> S. ASPHALT CONCRETE DHM: Yes ❑ No <br /> 6. BARRIERS along Right-of-Way lU�A -- <br /> 7. DITCH Yes tK No El If-Yes: V Style El Point El Other ElWidth Depth <br /> »»»»»»>»>»»>»»>»»»»»»»PERMIT REQUIREMENTS«««««««««««««««««««« <br /> 1. DRIVEWAY: SFR �Z COMMERCIAL ❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with "Min.Depth A.C.over "Min.Depth 3/4"A.B. <br /> Notes <br /> 2. Y]tPEtx Length of Pipe Required: <br /> Ft.and Diameter of Pipe Inch <br /> To be connected to any ad*ent driveway pipe Yes ❑ No CA <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total Length: (with proposed) Total Nu nber of Storm Drshi Inlets <br /> Notes <br /> 3. HEADWALL Yes Q No <br /> 4. PAVED FRONTAGE: PAVED with "Min.Depth A.C.over "Mia Depth 3/4"AB. <br /> Measuring Feet in length and Feet in width <br /> FEES <br /> Driveway Encroachment Permit base fee............................$85.00 <br /> Field Inspection <br /> $100.00+0.46/ft <br /> ElDriveway w/or w/o pipe................................................$95.00 ❑Paved frontage................................. <br /> ❑ Driveway w/box Culvert................................................$155.00 ❑Curb,Gutter,Sidewapk.......................$100.00+0.98/ft <br /> P 2 of Revised 8/2000 <br /> Counter\Computer,c:\Access\Application for Permits\Driveway and Paved Frontage <br /> Page <br />