Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: the descriptionm included in this application are correct to the best of his/her <br /> I. That he/she has read all the provisions ofthis application,and that <br /> knowlvudge;and <br /> 2. That he/she is the owner of the respective property,or is qualified to represent the owner;and <br /> >'tity for personal or damage to property which may arise out of the work described above, <br /> 3. That he/she will assume full responsibility for all fiab <br /> or which may arise out of his/her failure to do the work provided herein;and <br /> 4. That in the event any claim of such liability is made against the County of San Josgiun or any department,official or employee there"t he shall <br /> defend,indemnify and hold them and each of them harmless for such claim;and <br /> 5. That work shall be performed by the applicant and/or any representative of the applicant in the County Right-of-Way at the above indicated site <br /> with a valid San Joaquin County Encroachment permit;and <br /> 6. That if permission is granted as requested,he agrees to do the work described in accordance with all terms,conditions and restriction of this and any <br /> attached sheet,included as general or special IH provisions. <br /> Signature of Applicant-Title Date <br /> FIELD INSPECTOR COMMENTS <br /> > EXISTING CONDMONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None ❑ Dirt ❑ Gravel ;R Aggregate Base ❑ Paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING. Awaay1 from Pavement ❑ Towards Pavement El Flat Ig <br /> 3. PIPES: None 1a Existing-Tyle <br /> Other pipes in neighborhood: Yes ❑ No Approaches ❑ Cross Drain ❑ Size <br /> Attachment to neighbors pipe: Yes ❑ No <br /> 4. HEADWALL: Yes ❑ No �k <br /> 5. ASPHALT CONCRETE DIKE: Yes ❑ No jK <br /> 6. BARRIERS along Right-of-way IU14 <br /> 7. DTfCH Yes ❑ No [A Ifyes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»>»»»»»»»»»»»»»»»>PERMIT REQUIREMENTS«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR ❑ COMMERCIAL ❑ AGRICULTURE ❑ INDUSTRIAL. ❑ <br /> PAVED with 2 "Mia Depth A.C.over 4- _"Mia Depth 3/4"A.B. <br /> Notes <br /> 2.PIPE& Length of Pipe Required: Ft.and Diameter of Pipe Indra <br /> To be connected to any adjacent driveway pipe Yes ❑ No ❑ <br /> DRAINAGE INLET REQUIRED Yes ❑ No ❑ <br /> Total Length: (with proposed) Total Nmnber of Storm Dra1e lRbAs <br /> Notes <br /> 3. HEADWALL Yes ® No DU <br /> 4. PAVED FRONTAGE: PAVED with "Mia 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.......................... 85.0 <br /> Field Inspection <br /> ElDriveway w/or w/o pipe.............................._......_........ Paved&offage.......... . .....,..............$100.00+0.46/ft <br /> ❑Driveway w/box Culvert................................................$155.00 ❑Curb,Gutter,Sidewallc.......................$100.00+0.98/ft <br /> Counter\Computer,c:\Access\Application for Permits0riveway and Paved Frontage Page 2 of2 Revised 8/2000 <br />