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COU TY OF SAN JOAQUI <br />DEPARTME T OF PUBLIC WORKS STEVEN WINKLER <br />P.O.BOX 1810 -18 10 E.HAZELTON AVE UE Deputy Director <br />STOCKTON,CALIFORNIA 95205 MIKE SELLING <br />(209)468-3000 Deputy Director <br />FAX.(209)468-9324 THOMAS GAU <br />Chief Deputy DirectorTHOMASR.FLI "N <br />Director <br />BUILDING PERMIT APPLICATION CLEARANCE FORM <br />PS-I001404 <br />APN 053-240-05 QUAD:E <br />SITE ADDRESS:17252"1 HILLSlDE DRLODL CA <br />SETBACK INFORMATION: <br />Is the building site near a levee or watercourse: <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:~ <br />FLOODIDRAINAGE I FORMATIO : <br />Flood Zone:X 100-Year Flood Information,Elev 0 or Depth 0DFinishedFloorexemptfrom100-Year Flood informationDDrainageshallberetainedon-site (Residential) <br />Total Structure in Square Feet:_ <br />PROJECT TYPE CERTIFICATES REQUIRED REMARKS <br />D Residential I.Existing Elevation,cert.(Except AO <br />Zones) <br />2.Elevation Certification. <br />[K]Commercial I.Existing Elevation,Cert.(Except AO <br />Zones) <br />2.Elevation Certification or Flood <br />Proofing Certification. <br />0 Ag.Bldg.,Private Garage Wet Proofing: <br />and Storage Bldg. <br />APPLICANT SIG ATURE -TITLE:_~_--'::::"=_DATE:.;(1-~[10 <br />RESIDENTIAL DRlf'EWAY ONLLoPavedorConcreteDrivewayts)required prior to final occupancy.I acknowledge the Drrvewayts)will be paved as <br />required by the Encroachment Permit (EP)and inspected by the Department of Public Works prior to the Ftnal Building Inspection. <br />A TEMPORARY GRA VEL DRIVEWAY tJ>ACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br />[]]I acknowledge that the existing driveway i pay d with Concrete or Asphalt Concrete.therefore an Encroachment Permit <br />(EP)is not required.D ot Applicable <br />REVIEWEDBY,DATE,#-- <br />This form determines flood elevation zones and allows plan e ecking only.I acknowledge that all Public Works Conditions of Approval for the <br />proval may take time to process and delay release of Public Works approval.therefore <br />APPLICA T SIG ATURE -TITLE:_~=c..__-,=DATE:a(1-?;J (0