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<1 COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORKS FRITZ BUCHAN <br /> e P1' P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> tf F o � MICHAEL SELLING <br /> STOCKTON,CALIFORNIA 95205 <br /> (209)468-3000 FAX(209)468-9324 Deputy Director <br /> JIM STONE <br /> www.sjgov.org/pubworks Deputy Director <br /> ROGERJANES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1501053 <br /> APN 228-030-43 QUAD: SE <br /> SITE ADDRESS: I17ooE ST RT 120 HYMANT,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 /> X❑ Residential 1. Existing Elevation,cert.,(Except AO <br /> Zones) THE PROPERTY FRONTS HWY. 120 <br /> 2. Elevation Certification. <br /> 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 Drivewoy(s)required prior to final occupancy. l acknowledge the Driveiray(s)ivill be paved as <br /> requires(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 /> Not Applicable <br /> APPLICANT SIGNATURE-TITLE: DATE: <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-1501053)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: r 1 `� n\, DATE: <br />