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O�au�N C <br /> m K' COUNTY OF SAN JOAQUIN - <br /> 1 DEPARTMENT OF PUBLIC WORDS MIICE SELLING <br /> 1 P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> ;1 F as3 STOCICTON,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-1300899 <br /> APN 051-120-62 QUAD:_ NE <br /> SITE ADDRESS: 17036N LOCUST TREE 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: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 /> 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 /> Proofing Certification. <br /> Ag.Bldg.,Private Garage Wet Proofing:N <br /> and Storage Bldg. <br /> RESIDENTIAL DRIVEWAY ONLY: <br /> ❑ Paved or Concrete Driveivay(s)required prior to final occupancy. l acknowledge the Driveivay(s)ivill be paved as <br /> required by the Encroachment Permit(EP)and inspected by the Department of Public Worksprior to the Final Building Inspection. <br /> A TEMPORARY 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 /> ❑X Not Applicable q <br /> APPLICANT SIGNATURE-TI LE. J� DATE: <br /> REVIEWED Bl()/ `.—�® _®--- DATE: (1/-3-2613_ <br /> This form determines flood elevation zones and allows plan checking only. I acknowledge that all Public Works Conditions of Approval for the <br /> project(PS-1300899)shall be satisfied. The conditions of approval may take time to process and delay release of Public Works approval,therefore <br /> initiate processing of the Conditions as soon�6ssible. <br /> APPLICANT SIGNATURE-TI E• DATE: T <br />