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IN , <br /> z f ' y <br /> COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORDS FRITZ BUCIIMAN <br /> P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> f k oMIKE SELLING <br /> - STOCKTON,CALIFORNIA 95205 <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-1401756 <br /> APN 023-200-05 QUAD: NE <br /> SITE ADDRESS: 21718N CORD RDCLEK 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 0 <br /> ❑X 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 Wet Proofing:N <br /> and Storage Bldg. <br /> RESIDENTIAL DRIVEWAY ONLY: <br /> ❑ Paved or Concrete Drivenvay(s)required prior to final occapmncy. l ac7aemvledge the Drivetvay(s)will be paved as <br /> required by the Encroachment Permil(EP)and inspected by the Department ofPablic Works prior to the Final Building Inspection. <br /> A TEMPORARY GRAVEL DRIVEWAY APPROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> I acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete,therefore an Encroachment Pernat <br /> (EP)is not required. <br /> ❑ Not Applicable <br /> APPLICANT SIGNATURE-TITLE' DATE: //blj0 <br /> i <br /> '"7✓ -2G L� <br /> REVIEWED BY. DATE: <br /> This form determines flood elevation zones and allow n checking only. I acknowledge that all Public Works Conditions of Approval for the project <br /> (PS-1401756)shall be satisfied. The condition approv may takt time to process and clay release of Public Works approval,therefore initiate <br /> processing of the Conditions as soon as possi e. <br /> APPLICANT SIGNATURE-TITLE. DATE: zv / <br />