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COUNTY OF SAN JOAQUIN STEVEN WINKLER <br /> DEPARTMENT OF PUBLIC WORKS Deputy Director <br /> P.O.BOX 1810-1810 E.HAZELTON AVENUE MANUEL SOLORIO <br /> STOCKTON,CALIFORNIA 95205 Deputy Director <br /> (209)468-3000 THOMAS GAU <br /> THOMAS R. FLINN FAX(209)468-9324 Deputy Director <br /> Director <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> APN 019-180-37 <br /> SITE ADDRES 16505 E_HWY. 88,LOCKEFORD <br /> SETBACK INFORMATION: <br /> Is the building site near a levee or watercourse:❑Yes BNo I <br /> (Project must be setback 10 feet from the levee toe or 25 feet from the top of the watercourse bank) <br /> FLOOD/DRAINAGE INFORMATION: <br /> Flood Zone ©100-Year Flood Information, Elev=or Depth <br /> Finished Floor eaemp from I00-Year Flood Information © Yes ❑ No <br /> Drainage shall be retained on-site❑Yes ©No (Residential) <br /> "Total Structure <br /> PROJECT TYPE CERTIFICATES REQUIRED REMARKS <br /> W Residential 1_ Existing Elevation, Cert. ; <br /> (Except AO Zones) <br /> 2. Elevation Certification. <br /> ❑ Commercial I_ Existing Elevation, Cert. <br /> (Except AO Zones) <br /> 2, Elevation Certification or <br /> Flood Proofing Certification j <br /> ❑ Ag.Bldg.,Private <br /> Wet <br /> Garage and Storage Bldg. Proofing El YES ❑ NO <br /> RESIDENTIAL DRIVEWAY ONLY. <br /> ❑ Paved or Concrete Driveway(s)required before issuance of a F"snat lnspecdo I acknowledge the Driveways)will be <br /> paved as required by the Encroachment Permit(EP)and inspected by the Department of Public Works prior to the Final <br /> Building Inspection. <br /> © I acknowledge that the existing driveway 71'spead with Concrete.orAsphalt Concrete, therefore an Encroachment <br /> Permit(EP)is not required. <br /> APPLICANT SIG ATURE-TITLE: DATE: 7- <br /> REVIEWED <br /> `REVIEWED BY: DATE: <br /> This form determines flood elevation zones and allows plan checking only. I acknowledge that all Public Works Conditions of <br /> h Approval for the project shall be satisfied_ The conditions of approval may take time to process and delay release of <br /> Public Works approval,therefore initiate pr g of the Conditions as soon as possible. <br /> APPLICANT SIGNATURE-TITLEA DATE: 7- U 0 4 <br /> Counter/Compttter,c:\Aocess\BW1&ng Per App Clearance Form1$PACF Revue 8/ f <br /> I <br /> , <br />