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.IN <br /> y Cd <br /> 2 <br /> COUNTY OF SAN JOAQUIN <br /> 4.v � F. DEPARTMENT OF PUBLIC WORKS FR1TZ BUCHMAN <br /> P.O.BOX 1810- 1810 E.HAZELTON AVENUE Depuly Director <br /> FOR STOCKTON,CALIFORNIA 95205 MICHAEL SELLING <br /> (209)468-3000 FAX(209)468-9324 Deputy Director <br /> JIM STONE <br /> www.sjgov.orgtpubworks Deputy Director <br /> ROGERJANES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1501937 <br /> APN 055-320-25 QUAD: NW <br /> SITE ADDRESS: 14719N THORNTON RDLODI,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:X5 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 RE ULZED REMARKS <br /> Residential 1. Existing Elevation,cert.(Except AO <br /> Zones) <br /> 2. Elevation Certification. <br /> FX Commercial 1. Existing Elevation,Ceti.(Except AO <br /> Zones) <br /> r <br /> 2. Elevation Certification or Flood <br /> Proofing Certification. <br /> Ag.Bldg.,Private Garage Wet Proofing:N <br /> and Storage Bldg. <br /> RESIDEN7'1AL DRIVEWAYONLY: <br /> Paved or Concrete Driveway(s)required prior tonna!occnyancy. 1 acknowledge the Driveways)will be paved as <br /> required by the Encroachment Permit(EP)and inspected by the Department of Public Works prior to the Final Building Inspection. <br /> A TEWORARY GRAVEL DRIVEWAY APPROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> I acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete,therefore an Encroachment Permit <br /> (EP)is not required. <br /> Not Applicable <br /> APPLICANT SIGNATURE-Tri'LE: <br /> REVIEWED BY: 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-1501937)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. / <br /> APPLICANT SIGNATURE-TITLE: V' r TE: ` r— <br />