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a�lh <br /> COUNTY OF SAN JOAQUIN - <br /> DEPARTMENT OF PUBLIC WORKS MIKE SELLING <br /> c n P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy ty Director <br /> zi F o$N STOCKTON,CALIFORNIA 95205 FRITZ BUCHMAN <br /> THOMAS GAU (209)468-3000 FAX(209)468-9324 Deputy Director <br /> Director www.sjgov.org/pubworks ROGER JANES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1303100 <br /> APN 065-090-27 QUAD: NE <br /> SITE ADDRESS:9623N TULLY RDLIND,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 /> 0 Residential 1. Existing Elevation,cert.(Except AO <br /> Zones) <br /> 2. Elevation Certification. <br /> E] 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 DRIVEWAYONLY.- <br /> F] Paved or Concrete Drivervay(s)required prior to final occupancy. I acknowledge dre Driveivay(s)will be paved as <br /> required by the Encroachment Pennit(EP)and inspected by the Deparonent of Public Works prior to the Final Building Inspection. <br /> ATEMPORARY GRAVEL DRIVEWAY APPROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> FX I acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete,therefore an Encroachment Permit <br /> (EP)is not required. <br /> FINot Applicable <br /> APPLICANT SIGNATURE-TITLE: DATE: tl `2 <br /> REVIEWED B . _.-DATE: <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-1303100)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 possibl . <br /> APPLICANT SIGNATURE-TITLE: DATE: `Z <br />