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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PUBLIC WORKS <br />P.O. BOX 1810- 1810 E. HAZELTON AVENUE <br />STOCKTON, CALIFORNIA 95205 <br />(209) 468-3000 FAX (209) 468-9324 <br />www.sjgov.org/pubworks <br />FRITZ BUCHMAN <br />Deputy Director <br />MICHAEL SELLING <br />Deputy Director <br />JI1v1 STONE <br />Deputy Director <br />ROGER JANES <br />Business Administrator <br />BUILDING PERMIT APPLICATION CLEARANCE FORM <br />PS-1600066 <br />APN 101-022-10 QUAD: NE <br />SITE ADDRESS: 2625N BEYER LNSTOC, 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: X500 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 CERTIFICAI ES REQUIRED REMARKS <br />Residential I. Existing Elevation, cert. (Except AO <br />Zones) <br />2. Elevation Certification. 0 <br />X <br />Commercial 1. Existing Elevation, Cert. (Except AO <br />Zones) <br />2. Elevation Certification or Flood <br />Proofing Certification. <br />Ag. Bldg., Private Garage <br />and Storage Bldg. <br />Wet Proofing: N <br />RESIDENTIAL DRIVEWAY ONLY: <br />Paved or Concrete Driveway(s) required prior withal occupancy. I acknowledge the Driveway(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 APP • OACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br />I acknowledge that the existing drivew y is pa d with Concrete or Asphalt Concrete, therefore an Encroachment Permit <br />(EP) is not required. <br />Not Applicable <br />DATE: <br />REVIEWED BY: <br />This form determines flood elevation zones and allows pla thee ing only. I acknowledge that all Public Works Conditions of Approval for the project <br />(PS-1600066) shall be satisfied. The conditions of appr al / !"take time to process and delay release of Public Works approval, therefore initiate <br />processing of the Conditions as soon as possible. <br />Li. APPLICANT SIGNATURE - TITL DATE: I I <br />APPLICANT SIGNATURE - TITLE: