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"Min Depth %'AB.over <br />THE APPLICANT HEREBY CERTIFIES:.re J JlJt(fr e ~~fti'et:"PeR :2£~JDI-,llJeIAM ..~ <br />1..'That he/shehas read all the provisionsof this application,and thallhe description inciuded in this application are correctto the best ofhls/herknowledge;and <br />••:.6 .'2.That he/she isthe owner of the respective property,or is gualified 10 represent the owner;and <br />3.That he/shewill assume fuil responsibiiityfor ailliabiiity for persona;injury or damageto property which may arise out of the worlldescribedabove,or which may arise'out of hisiherfailure to do the work provided herein;and <br />4.That in the event any claim of such liabilityis made against the County of SanJoaquin or any department,official or employeethereof,he sh~i1de(end,indemnify and hold them end each of them harmless for such claim;anti <br />5.That wonl shall be performed by the applicant and/or any representative of !he application in the County Right.of.Way'atthe aboveindicatedsitewithavalidSanJoaquinCountyEncroachm.enjPermit;and . <br />6.That if permission is granted as requested,he agreesto do the work described in accordance Withail terms,condition and restrictionofthisandanyattachedsheet,included as general or spe.cialill provisions..'.£!2~.D~'/r,elJ1 tEMlf\ee.r .>-.:1.b -2.0 16'Signature of Appilci\nt ntie Y bale <br />»»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>FIELD lr!SPECTION COMMENTS<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<EXISTINGCONDITIONS, <br />" <br />1.DRIVEWAY:Noneflt Dirt 0 Gravel 0 Aggreg~te Base 0 Paved (poor)0 Paved (good)0 <br />2.SLOPING:Away from Pavement ttL-Towards Pavemant 0 Flat 0 . <br />3.PIPES:None Ii(Existing -Type ~~ <br />Other pipes in neighborhood:Yes 4'S)::No 0 ApproachesJ6foss Drain 0 Size-..: <br />4.HEADWAll:Yes 0 No tL-- <br />5.ASPHALT CONCRETE DiKE:.Yes 0 NO~ <br />6.BARRIERS:.aiong Right.of.Way _ <br />7.DITCH:'Yes ~No 0 IfYes:VStyie 0 2 Point 0 Other 0 Width Depth _ <br />»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>PERMITS REQUIREMENTS«<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< <br />1.DRIVEWAY:SFR 0 Commercial.M-Agricuiture 0 Industrial 0 <br />Paved ~t/]t:-"Min Depth AC.over 't::? <br />Notes: <br />It2.PIPES: <br />~otes: <br />length of Pipe Required FL and'Diameter of Pipe <br />To be connected to any adjacent driveway pipe Yes 0 No ~ <br />Drainage Inlet Required Yes 0 No jgj.- <br />Total length:(with proposed)Total Number of Storm Drain Inlets:_ <br />inch(es) <br />:.HEADWAll:Yes 0 No ~ <br />.PAVED FRONTAGE:Paved with 'Min Depth AC.over.'Min Depth %'A.B. <br />Measuring Feet in length and Feet in width <br />»»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>FEES«<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<««<<<<<<<<<<<<< <br />riveway Encroachment Permit base fee $135.00 <br />eld Inspection <br />Driveway wi or w/o pipe $121.00Drivewayw/box Culvert------$"181.00------ <br />:elTRAI.SERVlCES\CI.ER1CAlIPUB-sY.WK'W.ASTER.PS\ENCROACHMENT PERMIT ORJ\IBo'!AY.DOC f09l1J) <br />B Paved Frontage $116.00 +0.531ft.Curb,Gutter,Sidewaik $121.00 +1.16/ft. <br />P:>nto1nf1