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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PUBLIC WORKS <br />P.O. BOX 1810 - 1810 E. HAZELTON AVENUE <br />STOCKTON, CALIFORNIA 95205 <br />(209) 468-3000 FAX (209) 468-9324 <br />www.sjgov.org/pubworks <br />BUILDING PERMIT APPLICATION CLEARANCE FORM <br />PS -1501052 <br />APN 207-300-30 QUAD: SE <br />SITE ADDRESS: 27344E TIFFANI LNESCA, 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 />FLOODIDRAINAGE 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 />FRITZ BUCI MAN <br />Deputy Director <br />NIICHAEL SELLING <br />Deputy Director <br />JIM STONE <br />Deputy Director <br />ROGER JAMES <br />Business Administrator <br />PROJECT TYPE <br />CERTIFICATES REQUIRED <br />REMARKS <br />�X Residential <br />1. Existing Elevation, cert. (Except AO <br />Zones) <br />TIFFANI LANE IS A PRIVATE ROAD <br />2. Elevation Certification. <br />Commercial <br />1. Existing Elevation, Cert. (Except AO <br />Zones) <br />2. Elevation Certification or Flood <br />Proofing Certification. <br />L] Ag. Bldg., Private Garage <br />Wet Proofing: N <br />and Storage Bldg. <br />RESIDENTIAL DRIVEWAY ONLY: <br />Paved or Concrete Driveway(s) required prior to final occupancy. I acknowledge the Driveways) ivill 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 />1Not Applicable <br />� <br />/", n <br />APPLICANT SIGNATURE -TITLE: 1O <br />1'�✓ "h!Y/DATE: Z 7 -/s- <br />REVIEWED BN�/-�\ s� s-�- 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 -1501052) 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. /l <br />APPLICANT SIGNATURE - TITLE:vJ DATE: t �? �� <br />