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APPLICANT HEREBY RTHIEd that the description included in this application are correct to the beat of his/her <br /> Tbat he/she has read pm <br /> j koowlwdB� and <br /> or is qualifiedto r the owner; <br /> 2, That he/she is the ow=of the respective Prop '' cx damage Pte` s ,mm out ofthe work described above, <br /> nd <br /> q, That he will asp fullresp l'�ill liability far personalWM <br /> or which Wa3's a out of hislha fetters to do the wcukprovidedC San >� ° or y� <br /> thereof he shall <br /> "ty Of <br /> 4. That in the event any claim of arch liabiYty made agaimst for suds c}air�and <br /> defend,indemnify and hold them and each ofthem bamnless -of--Way at the above indicated site <br /> 5. That work shall be paf meed by <br /> the applicant andfac any saps of the applicant m The County Right <br /> t�fi end condition o suction of this and any <br /> with a valid San Joaquin � e�'Peast`4 he agrees to do <br /> the work bed <br /> accordance with all temps, and r <br /> 6. That if Peron ns granted as <br /> �sleet,included as general a special III provisions.attic <br /> /j) <br /> ` Date <br /> Sime Appy-Fine <br /> FIELD IlVSP,CTOR coNU ><NFS <br /> EXT' M(i CONDMONS«««««««««««««««««««« <br /> Dirt p Gravel ❑ Aggregate Baso ❑ <br /> P,Nea(po�) ❑ pav*Good) <br /> �.DR�wAY: crane ❑ Flat � <br /> Away from Pavammt � Towanda Pavmnent ❑ <br /> 2. SLOPING: �j <br /> 3. PIPES- Now ❑ Existing-Type p � p Cross Drain ❑ SAO <br /> Otho pipes in=W bmhoo& Yes No <br /> AmatobopsPiP Yea No ❑ <br /> 4 BEADWALL: Yea [I No <br /> S. ASPHALT CONCRETE DOM: Yea ❑ No <br /> 6. BARRIERS al0*R.rght-of-Way O p Widthepth <br /> 7. D1CS T <br /> Yes N No ❑ IfYos: V Style � Z Pout ❑ <br /> ENTS <br /> »»»»»»»»>>>>>>»»»»»»PERMIT AGRICIJLTURE ❑ INDUSTRIAL ElCOIvflNERCIAI. ❑ <br /> i.DRWEWAY: SFR (� "Min.Depth 3/4"A.B. <br /> PAVED with "Mia Depth A.C.over <br /> Notes <br /> of Inds <br /> L PIPES. Length of iPe ReVired: <br /> Ft sad DI <br /> — <br /> To be connected to any ad3acxnt <br /> driveway pipe Yea ❑ No <br /> .__ <br /> - DRAINAGE INLET REQUIRED <br /> Yes-,. No <br /> Total : _ '�proms) ToW Number of Storm Drift Inlets <br /> Nates <br /> 3. HEADWALL yes ® No <br /> Mia Depth 3/4"AB. <br /> PAVED with "Mnn.Depth A.C.over <br /> 4. PAVED FRONTAGE: Feet in width <br /> maiming ._. Fed in length and <br /> FEES <br /> il <br /> Driveway Encroachment Permit base fee..........:................ 5.0 <br /> Field Inspection $100.1)4+0.46/ft <br /> $95.0 ❑Pavedfra�ge••...._-._...........:"_�'• .$100.00+0.98/ft <br /> ❑ Driveway w/or w/o pipe......................... ...__... ._. .. ❑Curr.Gutta.Sidowallc....._............. <br /> $155.00 <br /> ❑Driveway w/box Culvert................................................ <br /> page 2 of 2 Revised 8/2000 <br /> CanatalComputer,c�:AcceaslAPpiicarion for pamda\Driveway,and Paved Frontage <br /> i <br />