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tsot� °oG <br /> nly— <br /> ial i <I CO NTA OF SAN JOAQUIN <br /> + DEPARTMENT OF PUBLIC WORKS FRITZ BUCHMAN <br /> -... P P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> r°1FQN <br /> STOCKTON,CALIFORNIA 95205 MIICESELLING <br /> THOMAS GAU (209)468-3000 FAX(209)468-9324 Deputy Director <br /> Director www.sjgov.org/pubworks JIM STONE <br /> Deputy Director <br /> ROGERJANES <br /> Buisiness Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1401820 <br /> APN 005-190-11 QUAD: NE <br /> SITE ADDRESS: 5786E COLLIER RDACAM,CA <br /> SETBACK INFORMATION: <br /> Is the building site near a levee or watercourse: N <br /> (Project must be setback 10 feet from the levee toe or 25 feet from the top of the watercourse bank) <br /> Total Volume of Retention Pond in Cubic Feet: 0 <br /> FLOOD/DRAINAGE INFORMATION: <br /> Flood Zone:X 100-Year Flood Information,Elev 0 or Depth O <br /> ❑ Finished Floor exempt from 100-Year Flood information <br /> ❑ Drainage shall be retained on-site (Residential) <br /> Total Structure in Square Feet: <br /> PROJECT TYPE CERTIFICATES REQUIRED REMARKS <br /> �X Residential 1. Existing Elevation,cert.(Except AO <br /> Zones) <br /> 2. Elevation Certification. <br /> ❑ Commercial 1. Existing Elevation,Cert.(Except AO <br /> Zones) <br /> 2. Elevation Certification or Flood <br /> Proofing Certification. <br /> Ag.Bldg.,Private Garage Wej Proofing:N <br /> and Storage Bldg. <br /> RESIDENTIAL DRIVEWAY ONLY: <br /> Paved or Concrete Driveway(s)required prior to final occupancy. I acknowledge the Driveivay(s)hill be paved as <br /> required by the Encroachlnenl Permit(EP)and inspected by the Deparanew ofPablic Works prior to the Final Building Inspection. <br /> A TEMPORARY GRAVEL DRIVEWAY APPROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> �X I acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete,therefore an Encroachment Permit <br /> (EP)is not required. . <br /> Not Applicable r <br /> APPLICANT SIGNATURE-TITLE:7DATE: Vt �•��y �y <br /> REVIEWED BY:�/,�/- ////// DATE: fJ Z;? <br /> This form determines flood elevation zones and allows.plan checking only. 1 acknowledge that all Public Works Conditions of Approval for the project <br /> (PS-1401820)shall be satisfied. The conditions of approval may take time to process and delay release of Public Works approval,therefore initiate <br /> processing of the Conditions as soon as possible. q��.�y_ fir` j <br /> APPLICANT SIGNATURE-TITLE��1 / (� DATE: r�1 1 <br />