Laserfiche WebLink
;> <br /> APPLICAP�T HERESY CERTHUS: <br /> and that the description inchrded in this application are correct to the bast of his/her . . <br /> Tient he/she has read all the provisions of this applustion, <br /> knowh*e;and <br /> That he/she is the owner of the respective property,�x is quaEfiedto rWes nt the owner,and <br /> 3. That he/she will assume full respMAM yfor all Haft for Persaani injury or damage t4 property whim arise out of the work described above, <br /> or Nachmay arise out of bus/her failure to do the wadcprovidedhereiu;and <br /> made the of San hereon or any department,oMCW or employee thereof,he shall <br /> 4, That in the event any claim of such IiabiYty against y <br /> defend,indemxtify and hold them and each ofthem hm nless for sucks claire;and <br /> f <br /> 5, That work shall be performed by the applicant and/or any rete othe applicant in the County%&-of-Way at the above indicated site <br /> with avalid San Joaquin County Encroachment Pernik;and <br /> 6. That if pem»ssion is greased as requested,he agrees to do the work described in accordance with all teams,eon&mss and restriction of this and any <br /> attached/Lmt indu,&dJ-as^-ameral err special 11 provisions. <br /> Signature of AppHcar&-Titre Data <br /> Fmm INSPECTOR cohB ENTS <br /> »»»»»»»»»»»»»»»»»»»»EXMT][ NO CONDMONS«««««««««««««««««««« <br /> L DRIVEWAY: Nose ❑ Dirt ❑ Graved ❑ Aggregate Baso R Paved*or) ElPav*Good) ❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Paven>ent ❑ Flat <br /> 3. PIPES- Now �- Existing-'type <br /> Otherpipmin� Yes El No Approaches ❑ Cense Drain El Size <br /> Attact to neighbors pipe: Yes ❑ No <br /> 4.HEADWALL: Yea ❑ No <br /> s. ASPHALT CONCRETE DUM: Yes ❑ No Ca <br /> 6. BARRIERS alae$Rigbt-c£Way <br /> 7. DTI CH Yes ❑ No Ifyes: V Style ❑ 2 Point ❑ f7ther ❑ Widitt Depth <br /> »»»»»»»»»»»»»»»»»»»»PERMIT REQLMMENTS<e««««««««««««««««««« <br /> 1.DRIVEWAY: SFR COMMERCIAL ❑ AORWMTURE ❑ INDUSTRIAL ❑ <br /> PAVED with "Min.Depth A.C.over ")Ain.Depth 3/4"A.B. <br /> Norm <br /> L PIPES: Iangth ofPipa R-pired: Ft.and Diame6a of'Pipe Inch <br /> To be conceded to any m9amot driveway Pipe Yea ❑ No <br /> I)RAIldAOE ML,ET REIVIRED 'flea ❑ No <br /> Total Length: (with proposed) Total Naber of Storm Drain Islets <br /> Notes <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAGE: PAVED with "Mia Depth AC.over "Mia.Depth 3/4"A.B. <br /> meamming Feet in length and Feet in width <br /> FEES <br /> Driveway Encroachment Permit base fee......................?395.00 <br /> Field Inspection <br /> ❑Driveway w/or w/o pipe.........................._......._..... ❑Paved fi�aahge-------_...._....:.._.._5100.00+0.46/8 <br /> ❑Driveway w/box Culvert........_......................_....... ❑Curb,outter,Sidewalk.....................$100.00+0.98/ft <br /> Counter\Computer,c:\Access\Application for Permits\Drivewsy and Paved Frontage Page 2 of 2 Revised 8/2000 <br /> 'ti <br />