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��qu.lN C <br /> COUNTY OF SAN JOAQUIN <br /> 4 DEPARTMENT OF PUBLIC WORKS FRITZ BUCIIMAN <br /> P� P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> ,_LJ Fr HFIf <br /> STOCKTON,CALIFORNIA 95205 MICHAEL SELLING <br /> (209)468-3000 FAX(209)468-9324 Deputy Director <br /> www.sjgov.org/pubworks JIM STONE <br /> Y Deputy Director <br /> ROGERJANES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1500568 <br /> APN 105-220-39 QUAD: NE <br /> SITE ADDRESS: 112N DIETRICH RDLBND,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 I. 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 /> ❑X Paved or Concrete Driveivay(s)required prior ro fnal occupancy. I acknowledge the Driveuzry(s)will be paved as <br /> required by the Encroachment Permit(EP)and inspected by the Department of Public 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 Permit <br /> (EP)is not required. ' <br /> ❑ Not Applicable <br /> APPLICANT SIGNATURE-TITLE: - DATE: / <br /> REVIEWED DATE: <br /> This form determines flood elevation zones and allows pit checking only.1 acknowledge that all Public Works Conditions of Approval for the project <br /> (PS-1500568)shall be satisfied. The conditions of ap oto al may take time t process and delay release of Public Works approval,therefore initiate <br /> processing of the Conditions as soon as possible. �` <br /> APPLICANT SIGNATURE-TITLE• " "—�ATE� S <br />