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'oda Co <br /> COUNTY OF SAN JOAQUIN <br /> H <br /> DEPARTMENT OF PUBLIC WORKS FRITZ BUCHMAN <br /> P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> STOCKTON,CALIFORNIA 95205 MME SELLING <br /> THOMAS GAO (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-1402737 <br /> APN 250-080-15 QUAD: SW <br /> SITE ADDRESS:227925 COZY CTTRAC,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 /> ❑ 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 Drlveway(s)required prior to final occuponey. I acknowledge the D"iveivay(s)ivill be paved as <br /> required by the Encroachment Permit(EP)and inspected by the Department of Public ff orks 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 <br /> i div <br /> APPLICANT SIGNATURE-TITLE 9k</: ._ DATE: > r <br /> REVIEWED BY: DATE: <br /> This form determines flood elevation zones and allows plan checking only. I acknowledge that all Public Works Conditions of Approval for the project <br /> (PS-1402737)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. <br /> APPLICANT SIGNATURE-TITLE: DATE: !��& -zm/ <br /> J <br />