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NIL " IEEE * °� BUILDING PERMIT APP � � rod J '' SITE INFORMATION AND AUTHORIZATION APPLICATION r' ` , M16p ISI San Joaquin County W:ftl� x �� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT •;' nit Develo ment Department ' 1810 E . HAZELTON AVENUE , STOCKTON CA 95205 k 1 Commu y p p MEE�._ -_ IF IF 1810 E . Hazelton Ave . , Stockton , CA 95205 _ _ . . tib% BUSINESS PHONE : (209) 468 -3121 'FIF, f' i' Phone (209) 468-3121 Fax (209) 468-3163 INSPECTION REQUEST-24 HOUR RECORDER : (209 ) 468-3165 Job Site Address : 21090 N . RAY ROAD LODI IF Cross Street: W ACAMPO RD THE APPLICATION MUST BE COELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING Owner Name : SMITH , PHILLIP L & JULIA A TR APN : 01302049 PERMITS , Owner Address : 1102 CHATEAU CT , LODI CA 95242-9166 Scope of Work : E/ fl X yU �� (� Precise Location : ON THE EAST SIDE OF N RAY RD . , 300 ' NORTH OF W ACAMPO RD . , LODI , CA Subdivision Name : - Lot# : - Historical Map App # : - Project Address : EFF 9 v ` [ Project Valuation : Current Zoning : AG -40 Setbacks : Front-30 ' Left- 10 ' Right- 10 ' Rear-15' Height-NA Contact E-mail : Fire District: WOODBRIDGE School Districts : LODI UNIFIED , LODI UNIFIED OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS Approved Use : AG STORAGE BUILDING Name : \e%%\ vo P r S Name : ylt •eL l � � � � _ Im rovement Plan Type Project Subtype : _ Address : \,o C\ v R Address : G 3 � u �� cK t MINOR : GENERAL : MAJOR : N/A: �X Planning Project # - Exp . Date : City: State : City: V ` S State : �� SPECIAL AREAS 1 ZIP : CJ ZIP : SExpansive Soil Area : NONEZ ZPh#( Subsidence Area : NONE Fire Hazard Area : none Airport Zone : none CONTRACTOR INFORMATION Ph#( ) Enterprise Zone : none SJAFCA: no* Lic. No : g) 5 ,3 1 y 'Z. Company Name : 41t %4 - Address : 1tu -Address : COMMENTS City: V St : ZIP : BP -21002886 ( ISSUED ) ; TO DEMO ( E) SFR PRIOR TO ISSUANCE OF DESIGNER INFORMATION Ph#( ) BUILDING PERMITS Lic . No : Company Name : Address : City: St : ZIP : LENDING AGENCY Ph#( ) Company Name : Address : Plan Check Only : ElFire Road Required : El tAl ��..t Inspection Area : 1A .. City: St: ZIP : Planning Approval : , � Date : 08 -31 -2021 IE Permit will be issued to an " Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY If yes , a completed Owner-Builder Verification Form must PUBLIC WORKS DEPARTMENT be signed and submitted along with copy of the owner's identification prior to issuance of the building permit . Verified owner's identification : Sewer District : none Water District: none Storm District : none DECLARATION BY CONSTRUCTION PERMIT APPLICANT El Q P ) �rIq�21 G14 40 be ��bFlr above Flood Certificate Required Prior to Final Inspection : Yes No 3y my signature below, I certify to one of the following : Storm Drainage Pond Required On -Site : Yes No 2 am ❑ a California licensed contractor or ❑ the property owner or ❑ authorized to act on the property owner's Total Volumne of Required Rentention Pond : ( Required for All On-site Ponds) 3ehalf (requires written a PS #: Z [ (, 3 ( q approval and Owner/Builder Verification Form signed and submitted ) . have read this construction permit application and certify the information I have provided is correct. I also agree to comply Preliminary Plan Check Clearance Approval : Date : vith all applicable county ordinances and state laws which govern this project . During the course of construction I will also All Public Works requirements have been met and release is akes steps to preserve all survey monuments . In addition , I authorize representatives of this county to enter the above- hereby approved for Building Permit issuance . Jentified property for insption purpo es . C No Release Certificate is required . IF kpplicant's Signature tr -�+ cis � `� #-c c.>9 - `� — 3 7 ' Date : 1Z� Date � 1 Public Works Approval Signature : Tor your convenience checklists detailin any additional submittal requirements for various building permit types re available at the Building Division counter. Demolition permit and mobile home on foundation require check-list. 4pplication Forms & Handouts\Building Forms and Handouts\Building Permit Application 10- 17 . doc (Revised ( 10-6- 17) Page 1 of 2