Laserfiche WebLink
THEE APPLICANT HEREBY CERTIFIES: <br /> 1. That he/she has read all the provisions of this application,and that the description irduded in this application are correct to the best of his/her <br /> knowlwdge',and <br /> 2. That he/she is the owner of the rive property,or is qualified to mart the owl and <br /> 3. That he/she will assume full responsibility for 211 fig l, l3'for personal i*",Or damage to property which may arise out of the work described above, <br /> or Anch 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 Joagiun of any department,official or employee thereof,he shall <br /> defend,indemnify and hold them and each of them harmless for such clairnc;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 III provisions. 3 <br /> C—Signature of Applicaul Tide Date <br /> FIELD INSPECTOR COMAENTS <br /> »»»»»»»»»»»»»»»»»»»»EXISTINQCONDITIONS«««««««««««««««««««« <br /> 1. DRIVEWAY: None Dirt ❑ Gravel ❑ Aggregate Base ❑ paved(poor) ❑ Paved(Good) ❑ <br /> 2. SLOPING: Away from Pavement ❑ Towards Pavement ❑ Flat <br /> 3. PIPES: Nacre Existing-Type <br /> Other pipes in neigbborhood: Yes ❑ No Approaches ❑ Cross Drain ❑ Sin C� <br /> AMLchment to noightwr's pipe: Yes ❑ No <br /> 4. HEADWALL: Yes ❑ No <br /> 5. ASPHALT CONCRETE DIRE: Yes ❑ No <br /> 6. BARRIERS along Rigt*-&Way <br /> 7. DITCH Yes ❑ No ® If Yes: V Style ❑ 2 Point ❑ Other ❑ Width Depth <br /> »»»»»»»»»»»»»»»»»»»»PERMIT REQUIREMENTS«««««««««««««««««««« <br /> 1.DRIVEWAY: SFR COMMERCIAL ❑ AGRICULTURE ❑ INDUSTRIAL. ❑ <br /> PAVED with "Min.Depth A.C.over "Min.Depth 3/4"A.B. <br /> Notes <br /> L PIPES: L—gth of Pipe Required: Ft and Diameter of Pipe Inch <br /> To be connected to any adjacent driveway pipe Yes ❑ No _. <br /> DRAINAGE INLET REQUIRED Yes ❑ No <br /> Total Ixngth: (with proposed) Total Number of Storm Drahr Inlets <br /> Nates <br /> 3. HEADWALL Yes ® No <br /> 4. PAVED FRONTAGE: PAVED with "Min.Depth A.C.over "Min.Depth 3/4"A.B. <br /> Measuring Fed 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 f a Cage._.............._........._....$100.00+0.46/ft <br /> ❑Driveway w/box Culvert. .....................$155.00 ❑Cult,Gutter,SidemWL......................$100.00+0.98/ft <br /> Counter\Computer,c:\Access\Application for Permits\Driveway and Paved Frontage Page 2 of 2 Revised 8/2000 <br /> l <br />