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Community Development Department 50 Diamond Valley Rd Markleeville, CA 96120 [PHONE REDACTED] Community Development Department - Address - STANDARD ENCROACHMENT PERMIT APPLICATION Cash Check In Compliance With Alpine County Code 12.08 and California Streets & Highways Code The Undersigned Hereby Applies For Permission To Construct The Following Improvement Or Otherwise Encroach Upon A County Road Reservation Or Right Of Way, As Follows: Complete all items below. If item is not applicable enter “N/A” Application is not complete until all required attachments are included. FOR COUNTY USE ONLY APPLICATION NUMBER: Date Received Entered By Total Permit Fee County Yard Assessor’s Parcel Number. County Road # Receipt No. Situs Address (Street Street or Road name Surety Amount EXCAVATION Maximum Depth Average Depth Average Width Length Road Surface Type PIPES Type Diameter Voltage or PSIG On which side of the County road will the work be performed? North South East West FULLY DESCRIBE WORK TO BE PERFORMED WITHIN COUNTY RIGHT OF WAY. (Who, What, Where, When, Why, How) Attach complete drawings sets) folded to 8.5”by 11” showing specifications, calculations, maps etc. Attach additional pages if necessary. Incomplete or illegible applications will be returned for correction. *Applicants for driveway encroachments must mark the intended driveway location by a stake with orange paint or flag bearing the applicants last name, the address, and the Assessor’s parcel number. ---PAGE BREAK--- Community Development Department 50 Diamond Valley Rd Markleeville, CA 96120 [PHONE REDACTED] Community Development Department - Address - The Undersigned Agrees that the work will be done in accordance with County Standards and Regulations and is subject to inspection and approval. In consideration of the granting of this application, the applicant hereby agrees to: 1. Indemnify, defend and save the County, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. 2. Remove or relocate an encroachment installed or maintained under this permit, upon written notice from the Community Development Department. 3. Notify the Community Development Department in writing at least 48 hours in advance of the time when work will be started, and upon completion of the work, immediately notify the Community Development Department in writing of such completion. 4. The permit applicant shall accept full responsibility for complying with Federal, State and County environmental laws receiving any necessary environmental clearances and/or permits, prior to commencing any work as authorized by this permit. Applicant, Agent or Responsible Person Address Telephone Signature Contractor Address Telephone License No. Property Owner Print Name Address Telephone Authorized Signature of Property Owner (Agent signing must include power of attorney) Date Signed Standard Encroachment Permit Conditions General Instructions 1. WORK MUST BE INSPECTED - work done without inspection may have to be removed and reconstructed. 2. PROTECTION – Provide enough barricades, lights, signs, cones, flaggers and other safety measures to protect the public, in accordance with the current California Manual on Uniform Traffic Control Devices. 3. TRAFFIC – A County road may not be closed to public traffic without the approval of the Board of Supervisors. Unless noted otherwise in the Permit Conditions, the permittee must keep a minimum 10 foot-wide travel lane open to traffic while working and at all other times the road shall be completely open for traffic. 4. STANDARDS – Work shall be in accordance with the latest Caltrans Standard Specifications and Plans as well as the County Standards Specifications and Plans. 5. UTILITIES – Utility relocations are the responsibility of the permittee. 6. UNDERGROUND SERVICE ALERT (USA) – Must be contacted in advance of any excavation in the road right-of-way. Any work found in progress without a valid USA number will shut down and the road cleared. 7. SURVEY MONUMENTS SHALL BE PROTECTED – Any survey monuments removed or disturbed shall be replaced using surveying practices acceptable to the County Surveyor. ---PAGE BREAK--- Community Development Department 50 Diamond Valley Rd Markleeville, CA 96120 [PHONE REDACTED] Community Development Department - Address - 8. Field Changes – Any modifications due to field conditions must be approved by the inspector. 9. STAFF CHARGES – Permittee is responsible for all staff charges associated with the permit. Any exceptions must be resolved before the permit is issued. 10. IF WORK IS PERFORMED WITHOUT PERMIT – All work is subject to removal and/or reinstallation. The Fee for working without a permit shall DOUBLE the amount on the fee schedule. Special Requirements – Driveways (Driveways shall be constructed from edge of pavement to property line) 1. Minimum Driveway construction shall be 2 inches of Asphalt Pavement on 6 inches of Class 2 Aggregate Base. Concrete Driveways shall be a minimum of 6 inches Class 3 concrete over 3 inches of Class 2 Aggregate Base. The Driveway is to be sloped to prevent Stormwater runoff to flow on to the County road and shall not interfere with roadside drainage or cause erosion or deposition of silt. 2. Driveway location shall comply with County standards and shall not interfere with a legal encroachment or cause a hazard or nuisance. 3. Where Driveways connect to County roads without curbs, shape a valley gutter across the Driveway such that the flow line matches the flow line of the roadside ditch or install a culvert (minimum diameter 18 inches) across the entire driveway matching the flow line of the culvert with the flow line of the roadside ditch. Special Requirements – Road Cuts 1. TRENCH EXCAVATION – Trench excavation and backfill requirements shall be in accordance with County Standard unless specifically approved by the Community Services Director or the inspector. 2. TEMPORARY PAVING (1.5 inches Type A Asphalt Concrete) or PLATING must be placed at the end of each work day. 3. NO JETTING is ALLOWED under any paved County road or within 4 feet from the existing edge of pavement. Trench compaction is to be achieved by impact, vibration or combination.