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xt <br /> COUNTY OF SAN JOAQUIN <br /> I DEPARTMENT OF PUBLIC WORKS FRITZ BUCHMAN <br /> °J <br /> .p --t f P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> �a?:lFo N MICHAEL SELLING <br /> STOCKTON,CALIFORNIA 95205 <br /> KRIS BALAJI (209)468-3000 FAX(209)468-9324 Deputy Director <br /> JIM STONE <br /> Director www.sjgov.org/pubworks Deputy Director <br /> ROGERJANES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1600308 <br /> APN 205-080-11 QUAD: SE <br /> .SITE ADDRESS: 19801E ST RT 120 HYESCA,CA i <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 /> FX Residential 1. Existing Elevation,cert.(Except AO <br /> Zones) HWY. 120 <br /> 2. Elevation Certification. <br /> ❑ Commercial 1. Existing Elevation,Ceti.(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 /> F] Paved or Concrete Driveway(s)required prior to final occupancy. 1 acknowledge the Driveivay(s)will be paved as <br /> required by the Encroachment Perini((EP)and inspected by the Deparhnegt ojPublic Works prior to the Final Building Inspection. <br /> A TEMPORARY GRAVEL DRIVEWAY APPROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. _ <br /> ElI acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete,therefore an Encroaclnnent Permit <br /> (EP)is not required. <br /> ❑% Not Applicable <br /> APPLICANT SIGNATURE-TITLE:,,,,;, DATE: <br /> �` DATE: 2 <br /> REVIEWED BY:v �� '��� <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-1600308)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. S /� <br /> APPLICANT SIGNATURE-TITLE: L DATE: C�vry <br />