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THE APPLICANT HEREBY CERTIFIES: <br />1.That helshe has read all the'provisions of this application,andthat the description inciuded in this application are correCt to the best ofhislherImowiedge;and .. <br />2.That helshe is the owner of the respective propeliy,or is guaiified to represent th~owner;and <br />3.That helshe will assume full responsibility for all liabilityfor persona;injury or damage to property which may anse out of the workdescribedaboye,or which may anse'out of his/herfaiiure 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 Joaquin or any department,official or employeethereof,he sh911 de(end,indemnify and hold theln and eachof them harmless for such claim;and <br />5.That worl(shall be performed by the applicant andlor any representative of the application in tile County Right-of-Way at the aboveindicatedsitewithavalidSanJoaquinCountyEncroachm.entPermit;and . <br />6.That if permission is granted as requested,he agreesto do the work described in accordance with all terms,condition and restriction <br />of this and any atiach~d s!Jijet,included as general orspe.cial III provisions..,..'.'.CcZ)-JJ-L_ca~~-lj-g-c7()/((Y <br />Signature of Applicant Ii Date <br />>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>FIELD INSPECTION COMMENTS««<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<EXISTING CONDITIONS..\. <br />1.DRIVEWAY:None D Dirt D Gravel D Aggregate Base D Paved (poor)D Paved (go~d)D <br />2.SLOPING:Away ITomPavement D Towards Pavement D Flat D <br />3.PIPES:None 0 Existing-Type.---'- <br />Other pipes in neighborhood:Yes D No D Approaches D Cross Drain 0 Size_ <br />4.HEADWAll:Yes D No 0 <br />5.ASPHALT CONCRETE DIKE:.Yes 0 No D <br />6.BARRIERS:along Right-of-Way _ <br />7.DITCH:Yes D No D If Yes:V Style D 2 Point D Other 0 Width _Depth _ <br />»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>PERMITS REQUIREMENTS«««<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<' <br />1.DRIVEWAY:SFR 0 Commercial D Agncuiture D Industrial D <br />Paved with "Min Depth AC.over "Min Depth %"AB.over <br />Notes: <br />2.PiPES:length of Pipe Required Ft.and Diameter of Pipe inch(es) <br />To be connected to any adjacent driveway pipe Yes D No D <br />Drainage Inlet Required .Yes D No D <br />Total length:.(with proposed)Total Number of Storm Drain Inlets:_ <br />Notes: <br />3.HEADWAll:Yes D No 0 <br />4.PAVED FRONTAGE:Paved with "Min Depth AC.over "Min Depth %"AB. <br />Measuring Feetin length and .Feetin width <br />»»»»»>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>FEES««<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<««««««««< <br />Driveway Encroachment Permit base fee $135.00 <br />•$121.00t$181.00 <br />1.\"'I:~rtQM~l:o\n('=It"'1CDIf'~1101 Ie O'",",v'''''rrco O<:'1<:""DI'lM"'LIl.'<:l<ITDI:DUIT "[,,I1~".V,.,,.,,,tnOI1~\ <br />B Paved Frontage~$116.00 +0.53/ft.Curb,Gutter,Sidewalk $121.00+1.161ft.---