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COUNTY OF SAN JOAQUIN STEVEN WINKLER <br /> DEPARTMENT OF PUBLIC WORKS Deputy Director <br /> < P.O.BOX 1810-1810 E.HAZELTON AVF,NUE MANUEL SOLORIO <br /> STOCKTON,CALIFORMA952M Deputy Director <br /> (209)468-3000 THOMAS GAU <br /> THOMAS R.FLINN FAX(209)468-9324 Deputy Director <br /> Director <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> APN 255-340-01 <br /> SITE ADDRES 31411 S KASSON RD. <br /> SETBACK INFORMATION: <br /> Is the building site near a levee or watercourse:BYes ❑No <br /> I <br /> (Project must be setback 10 feet from the levee toe or 25 feet from the top of the watercourse bank) <br /> FLOOD/DRAINAGE INFORMATION: <br /> Flood Zone ©100-Year Flood Information, Elev 0 or Depth <br /> Finished Floor exempt from 100-Year Flood Information ❑✓ Yes ❑ No <br /> Drainage shall be retained on-site E)Yes ©No (Residential) <br /> Total Structure <br /> PROJECT TYPE CERTIFICATES REQUIRED REMARKS <br /> 0 Residential 1. Existing Elevation,Cert. <br /> (Except AO Zones) <br /> 2. Elevation Certification. <br /> ❑ Commercial 1. Existing Elevation,Cert. <br /> (Except AO Zones) <br /> 2. Elevation Certification or <br /> Flood Proofing Certification <br /> ❑ Ag.Bldg.,Private Garage Wet <br /> and Storage Bldg. Proofing ❑YES ❑ NO <br /> RESIDENTIAL DRIVEWAY ONLY: <br /> Paved or Concrete Driveway(s)required before issuance of a Final Inspectio I acknowledge the Drivemay(s)will be <br /> paved as required by the Encroachment Permit(EP)and inspected by the Department of Public Works prior to the Final <br /> Building Inspection. <br /> ❑ I acknowledge that the existing driveway is paved with Concrete or Asphalt Concrete, therefore an Encroachment <br /> Permit(EP)is not required. <br /> APPLICANT SIGNA -TITL DATE: S 03 <br /> REVIEWED BY: DATE: 4S o <br /> This form determines fl elevation zones and allows plan checking only. I acknowledge that all Public Works Conditions of <br /> Approval for the project F______1 shall be satisfied. The conditions of approval may take time to process and delay release of <br /> Public Works approval,therefore initiate processing of the Conditions as soon as possible. <br /> APPLICANT SIGNATURE-TITLE G" ATE: <br /> Counter/Computes,cAAccessSudding Per App Clearance Fon&PACF Revised 812000 <br />