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a <' COUNTY OF SAN JOAQUIN <br /> DEPARTMENT OF PUBLIC WORKS MIKE SELLING <br /> P.O.BOX 1810- 1810 E.HAZELTON AVENUE Deputy Director <br /> K�f j F o Nta�� <br /> STOCKTON, CALIFORNIA 95205 FRITZ BUCHMAN <br /> THOMAS GAU (209)468-3000 FAX(209)468-9324 Deputy Director <br /> Director www.sjgov.org/pubworks ROGER JAMES <br /> Business Administrator <br /> BUff LDffNC PERIt`✓) T APPLICATION CLEARANCE FORM <br /> PS-1300125 <br /> APN 063-210-16 QUAD: NE <br /> SITE ADDRESS: 11975N JACK TONE 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 /> [X Residential 1. Existing Elevation,cert. (Except AO <br /> Zones) <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 DRI VEWAYONLY.- <br /> ❑ Paved or Concrete Drivmvay(s)required prior to final oempaiicy. I acknowledge the Driveipay(s)roill 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 /> QX I 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:t'L ` �.•.. DATE: <br /> REVIEWED BY: DATE: J� <br /> This form determines flood elevatizones and allows plan checking only. I acknowledge that all Public Works Conditions of Approval for the <br /> project(PS-1300125)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 as possible. <br /> APPLICANT SIGNATURE-TITLE: DATE:'r <br />