Laserfiche WebLink
THE APPLICANT HEREBY CERTIFIES: <br />1.Thathelshe has read all the'provisionsof this'application,andthat the desc;iption included in this application are correct to the bestofhislherImowledge;and <br />2.That helshe is the owner of the respectiveproperty,or is gualified to represent th~owner,and <br />3.That helshe will assume full responsibilityfor aliliabiiity for persona;injury or damage to property which may arise out of the worlldescribedabove,or which may arise'out of his/herfailuretodo the worll provided herein;and <br />4.That in theevent any claim of such Iiabiiityis madeagainst the Countyof San Joaquin or any department,official or employeethereof,he shallde(end,indemnify andholdthem and each ofthem harmless for such claim;and <br />5.That worll shall be performed by the applicantandlor anyrepresentativeof the application in tlle County Right-of-Way at the aboveindicatedsilewithavalidSanJoaquinCountyEncroachmentPermit;and . <br />6.That if permission is grante requested,he greesto do the work described in accordancewith all terms,condition and restrictionofthisandanyatlh,included as neralor spec/allll provisions. <br />7~3-~J~/~ <br />Signature of Applicant Title Date <br />»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>fIElD INSPECTIONCO~A~~ENTS<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<EXISTINGCONDITIONS <br />1.DRIVEWAY: <br />2.SLOPING: <br />3.PIPES: <br />4.HEADWAll: <br />". <br />None /J6 Dirt 0 Gravel 0 Aggregate Base 0 Paved (poor)0 Pav~d (good)0 <br />Away from Pavement 0 Towards Pavement 0 flat~ <br />None oM Existing-Type.-M~~_ <br />Other pipes in neighborhood:Yes 0 No Ii"Ii:Approaches 0 Cross Drain 0 Size _ <br />Yes 0 No J!{ <br />5.ASPHALT CONCRETEDIKE:.Yes 0 No ~ <br />6.BARRIERS:along Right-of-Way ~_ <br />7.DITCH:Yes 0 No ~If Yes:V Style 0 2 Point 0 Other 0 Width Depth _ <br />»»»»»»»»»»»»»»»»»»»»»»»»PERMITSREQUIREMENTS««««««««««««««««««««<< <br />1.DRIVEWAY:SfR.M Commercial 0 Agriculture 0 Industrial 0 . <br />pave:tiJ 2-"Min DepthA.C.over .4 "Min Depth 'y.'AB.over <br />Notes: <br />2.PIPES: <br />Notes: <br />length of Pipe Required fl <br />To be connected to any adjacent driveway pipe Yes 0 <br />Drainage Inlet Required Yes 0 <br />Total length:.(with proposed) <br />ft.and Diameter of Pipe inch(es)~~lTotalNumberofStormDrain Inlets:_ <br />3.HEADWAll:Yes 0 <br />4.PAVED FRONTAGE:P:t!th "Min DepthAC.over,'Min Depth'y.'AB. <br />Measuring Feet in length and ~feet in width <br />»»»»»»»»»»»»»»»»»»»»»»»»»»»fEES««««««««««««««««««««««««««« <br />Driveway Encroachment Permit base fee..$135.00 <br />_____$121.00 <br />~$181.00 <br />U:ICEmRALSERVlCESlCLER1CAL \PIJB-SVWKIMA~TFR P::\\FNCROArJ-llJFNT PERMIT DRl'JEVIIAY.DOG (09/131 <br />B Paved Frontage____,$116.00+0.53Ift.Curb,Gutler,Sidewalk $121.00 +1.161ft. <br />PilllR2nf2