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.1 •••••• <br />THE APPLICANT HEREBY CERTIFIES: <br />1.That he/she hasread all the'provisionsof this application,and that the description included in this application are correello thp best of • <br />his/her knowledge;and ., <br />2.That he/she isthe owner of the respective property,or is gualified to represent th~owner;and.. <br />3.That he/she will assume full responsibilityfor all iiabilityfor persona;injury or damage to property which may anse out of the wonldescribedabove,or which may anse'out of hislherfailure to do the work provided herein;and <br />4.That in the event any claimof such liabilityis made againstthe County of San Joaquin or any department,official or employeethereof,he sh~1Ide(end,indemnify and hold themandeach ofthem hannless for suchclaim;and . <br />5.Tha!worl(shall'be performed by the applicantand/or any representative of \he applicationin the County Right-of-Way-at the aboveindicatedsitewithavalidSanJoaquinCountyEncroachm.enjPermit;and <br />6.That if permission is granted as requested,he agreesto do the work descnbed in accordancewith all terms,condition and restrictionofthisandanyaffachedsheet,included as general or sPecial IIIprovisions.'.,/l~ex-~J;._I{-f{'7s~of Applicantl1tie ~'date <br />>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>FIELD INSPECTIONCOMMENTS<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<EXISTING CONDITIONS.,\ <br />1.DRIVEWAY:None,a1'Dirt 0 Gravel 0 Aggreg~te Base 0 Paved (poor)0 Paved (good)0 <br />2.SLOPING:Away from Pavement 0 Towards Pavement 0 Flat ikI <br />3.PIPES:None 0 Existing-Type..-itT~~-~-~~~~~~~-Other pipes in neighborhood:YeS Jl6 No 0 Approaches/iil Cross Drain 0 Size~~~_ <br />4.HEADWALL:Yes 0 No!;f . <br />5.ASPHALT CONCRETE DIKE:,Yes 0 No ~. <br />6.BARRIERS:along Right-of-Way ~~_~~~_~~~~~~~~~~~~~~~~~~~~~_ <br />7.DITCH:.Yes JiJ No 0 If Yes:V Style 0 2 Point 0 Other 0 Width Depth _ <br />»»»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>PERMITS REQUIREMENTS<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<,. <br />1.DRIVEWAY:SFR q Commercial 0 Agnculture 0 Industrial 0 <br />Paved wit/]"Min Depth AC.over 'Min Depth'}'.'AB.over <br />Notes: <br />~2.PIPES: <br />Notes: <br />Length of Pipe Required Ft and'Diameter of Pipe <br />To be connected to any adjacent driveway pipe Yes 0 No in'.Drainage Inlet Required Yes 0 No <br />Total Length:'(with proposed)Total Nu ber of Storm Drain Inlets:_ <br />inch(es) <br />3.HEADWALL:Yes 0 No J1Q <br />4.PAVED FRONTAGE:Paved with ",fA 'Min Depth AC.over "Min Depth '}'."A.B.Measuring I Feet in length and -----Feet in width <br />»»»»»»»»»»»»»»»»>>>>>>>>>>>>>>>>>>>>>>FEES«««««««««««<<<<<<<<<<<<<<<«<<<<<<<<<<<<<<< <br />Dnveway Encroachment Permit base fee $135.00 <br />______$,121.00 <br />t $181.00 <br />U-4r~4r _~n~~~r~41\PIIR..f:;\,W\{\U4.~~~';.)('4~I4lRIT PFRMfTnRIVP.NAY,OOC f09l1J\ <br />El Paved Frontage $.116.00+0.53/ft.Curb,Gutter,Sidewalk $121.00+1.16/ft. <br />Pa1l92nf2