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ev <br /> Department of Public Works <br /> SAN�JUQQUINKris Bala i Director of Public Works <br /> COUNTY— Fritz Buchman,Deputy Director/Development <br /> Greatness grows her, Jim Stone,Deputy Director/Operations <br /> wig for YOU Najee Zarif,Interm Deputy Director/Engineering <br /> Kristi Rhea,Manager of Strategic Indiatives <br /> BUILDING PERMIT APPLICATION CLEARANCE FORINT <br /> PS-2000652 <br /> APN 058-070-23 QUAD: NW <br /> SITE ADDRESS: 12828N LWR SACRAMENTO 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: 5 100-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 /> X❑ Commercial 1. Existing Elevation,Cert.(Except AO <br /> Zones) <br /> 2. Elevation Certification or Flood <br /> ,ProofingCertification. <br /> ❑ Ag.Bldg.,Private Garage Wet Proofing:N <br /> and Storage Bldg. <br /> RESIDENTIAL DRIVEWAY ONLY: <br /> Paved or Concrete Driveways)required prior to final occupancy. I 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 TEMPORARY GRAVEL DRIVEWAY APPROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> ElI acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete,therefore an Encroachment Permit <br /> (EP)is not required. <br /> ❑X Not Applicable <br /> M c� t��^ 3 s z-oZa <br /> APPLICANT SIGNATURE-TITLE: DATE: <br /> REVIEWED BY: Z:; DATE: Z6l <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-2000652)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 posstb <br /> APPLICANT SIGNATURE-TITLE: L DATE: <br /> 1810 East Hazelton Avenue Stockton, California 95205 1 T 209 468 3000 1 F 209 468 2999 <br />