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4m COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORDS FRITZ BUCHMAN <br /> e c e P.O.BOX 1810- 1810 E.FIAZELTON AVENUE Deputy Director' <br /> STOCICTON,CALIFORNIA 95205 MIKE SELLING <br /> THOMAS GAU (209)468-3000 FAX(209)468-9324 Deputy Director <br /> Director www.sjgov.org/pubworlcs JIM STONE <br /> DeputyDirector <br /> ROGER JANES <br /> Buisiness Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1402531 <br /> APN 207-300-21 QUAD: SE <br /> .SITE ADDRESS: 27531E TIFFANI LNESCA,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 /> ❑ 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 /> 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 /> ❑X Ag.Bldg.,Private Garage Wet Proofing:N <br /> and Storage Bldg. <br /> RESIDL•NTML DR]PFTVA Y ONLY- <br /> Paved or Concrete Driveway(s)required prior to final occupancy. I acknowledge the Drivemay(s)mill be paved as <br /> required by the Encroachment Penvnit(EP)and inspected by the Deparanew of Pub He Works prior to the Final Building Inspection. <br /> A TEMPORARY GRAVEL DRIVEWAY APPROACHVPIALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> E] I acknowledge that the existing driveway is paved with. oncrete or Asphalt Concrete,therefore an Encroachment Pennit <br /> (EP)isnot required. / <br /> Not Applicable ZD <br /> APPLICANT SIGNATURE-TITLE: / DATE: <br /> REVIEWED BY: DATE: - <br /> This form determines flood elevation zones and allows plan checjCi g only. I acknowledge that all Public Works Conditions of Approval for the project <br /> (PS-1402531)shall be satisfied. The conditions of approval i y take t o process and delay release of Public Works approval,therefore initiate <br /> processing of the Conditions as soon as possible. <br /> APPLICANT SIGNATURE-TITLE: L/ DATE: <br />