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THE APPLICANT HEREBY CERT S: <br /> That he/she has lead all the provisions of this application,and that the description included in this application are rmrfect to the best of his/her <br /> ki11lwd9v,and <br /> or is ed to the owl strict <br /> 2, Tbat he/she is the owner'of the respective property, qualiii replYS�t <br /> 3. That he/she will A��+TMru'full responsib',7itYf�r ill lianddy fox personal mgary cx damage to piopmty wlndn may arise out ofthe work described above, <br /> or which may arise out of bisque'failure to do the wor1c provided hetvin;and <br /> 4. That in the event any claim of such liabiKty <br /> ismade against the Cot-ty of San hragiun or any department,.official employee thereof;he shall <br /> defend,indenmify and hold tbem and each ofthean harmless for such claim;and <br /> �6 of the applicant in the County Right of-Way at the above indicated site <br /> 5. That work shall be performed by the applicant and/or any re <br /> with a valid San Joaquin County EunoaclmnOt Permit;and <br /> 6. That ifpennission is Wanted as requested,he agrees to do the work described in accordance with all tams,conditions and restriction of this and zany <br /> attached III <br /> included as general or special pro / v n <br /> 67 Signature of Applicxr-Titre Dais <br /> - HELD INSPECTOR COAEMNTS <br /> E IS'TINGC0NDM4DNS«««<<<<<<««««««««««« <br /> I. DRIVWAY: Nome .� Dirt Gravel ❑ Aggregate Base ElPaved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away front Paves ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: None Ending-Type <br /> Other pipes in hood: Yes ® No ❑ Approaches ❑ Cross Drain ❑ Size /Z C <br /> Attad�eat to s Pte: Yes ❑ No <br /> 4.mEADWALL: Yos El No ❑ <br /> S. ASPHALT CONCRETE DACE: Yes ❑ No <br /> G BARRIERS along Rigbt�Way /u/A• - <br /> Depth <br /> 7. DITCH Yes E] No E] Ifyes: V We E] 2 Point ❑ tither ElWidth <br /> »»»»»>»»»»»»»»»»»»»»>PERMIT REQUIREMENTS«««««««<<<<< ««««««« <br /> 1. DRIVEWAY: SFR COMMERCIAL ❑ AGRICULTURE ❑ INDUSTRIAL ❑ <br /> PAVED with "Min.Depth A.C.over "Mia Depth 3/4"A.B. <br /> Notes <br /> PIPFt and Diametw o£Pipe Inch <br /> 2. E& �� —.. <br /> To be connected to any adaceot driveway pipeYes ❑ No <br /> DRAINAGE INLET REQUIRED Yea ❑ No <br /> Total Laigth: (with proposed) To/ai Number of Storm Drain Meta <br /> Nates <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAGE: PAVED with "Mm.Depth AC.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 /> Feld Inspection <br /> El Driveway wor w/o P/ i _.._. S.dlO ❑Paved frontage-....... . ...--...:..- ..$100.00+0.46/ft <br /> Inc.........................._..._.._. <br /> ❑Driveway w/box Cknlve ................................................$155.00 ❑Curb,Gutter,Sidewalk.......................$100.00+0.98/ft <br /> CountertComputer,c: \Applicahon for Permils\Dnveway and Paved Frontage Page 2 of 2 Revised 8/2000 <br />