Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: < <br /> 1. That he/she las read all the provisions of this application,and that the description included in this application are correct to the best of his/her <br /> knowhxdge;and <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 assume full responsibility for all liability for personal injury or damage to property which may arise out ofthe work described above, <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 Joaqum or any departmeut,official or employee thereof 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 Rigbt-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 an terms,coaditiens and restriction oftbis and any <br /> attached sheet;included as general al III proven' <br /> p &�� <br /> iguature of Applicaii-Title Date <br /> FIELD INSPECTOR CODCUENTS <br /> »»»»»»>EXISTING CONDITIONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None ® Dirt ❑ Gravel ❑ Aggregate Base ❑ Paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: None N Existing-Type <br /> Other pipes in neighborhood. Yes ❑ No �Z Approaches ❑ Cross Drain ❑ Size <br /> Attachment to neighbor's pipe: Yes ❑ No <br /> 4. HEADWALL: Yes ❑ No JR <br /> 5. ASPHALT CONCRETE DI[fE: Yes ❑ No <br /> 6. BARRIERS along Right-o€-Way <br /> 7. DITCH Yes ❑ No ® If Yea: V Style ❑ 2 Point ❑ Other ❑ width Depth <br /> »»»»»»»»»»»»»»»»»»»»PERMIT REQUIREMENTS«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR L@ COMMERCIAL ❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with "Min Depth A.C.over "Mia.Depth 3/4"A.B. <br /> Notes 1-7 <br /> 2. PIPES: I—&*of Pipe Required: Ft and Diameter of Pipe Indy <br /> To be connected to any adjacent driveway pipe Yes ❑ No �] <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total Length: (with proposed) Total Numiber of Storm Drain Inlets <br /> Notes F_ <br /> 3. HEADWALL Yes ® No X <br /> 4. PAVED FRONTAGE: PAVED with "Min.Depth A.C.over "Min Depth 3/4"A.B. <br /> Measuring Feet in length and Feet in width <br /> FEES <br /> Driveway Encroachment Permit base fee...........................$85.00 <br /> Field Inspection <br /> ❑Driveway w/or w/o pipe............................................. ..$95.00 ❑Paved frontage..................................$100.00+0.46/ft <br /> EJ <br /> Driveway w/box Culvert................................................$155.00 <br /> ❑Curb,Gutter,Sidewalk......................$100.00+0.98/ft <br /> CounterlComputer,c:\AccesstApplication for PermitslDriveway and Paved Frontage Page 2 of 2 Revised 8/2000 <br />