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O•:�L:r.r�p� <br /> y <br /> 4� COUNTY OF SAN JOAQUIN STEVEN WINKLER <br /> DEPARTMENT OF PUBLIC WORKS Deputy Director <br /> P.O. BOX 1810- 1810 E.HAZELTON AVENUE MIKE SELLING <br /> y1'I F o s STOCKTON,CALIFORNIA 95205 Deputy Director <br /> THOMAS GAU (209)468-3000 FAX(209)468-9324 FRITZ BUCHMAN <br /> Director www.sjgov.org/pubworks Deputy Director <br /> ROGERJAMES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1201637 <br /> APN 253-250-31 QUAD: SW <br /> SITE ADDRESS: 570OW DURHAM FERRY RDTRAC,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 Driveway(s)required prior to final occupancy. I acknowledge the Driveways)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 Aspbalt Concrete,therefore an Encroachment Permit <br /> (EP)is not required. <br /> 0 Not Applicable _ <br /> J : <br /> APPLICANT SIGNATURE-TITLE: 1�LDATE: / -- - <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 <br /> project(PS-1201637)shall be satisfied. The conditionsof approval may take time to process and delay release of Public Works approval,therefore <br /> initiate In of the Conditions as soon as possible. M <br /> APPLICANT SIGNATURE-TITLE:, k- � _ DATE: be' 7-)Y-12— <br />