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COUNTY OF SAN JOAQUIN <br /> MIKE SELLING <br /> �. <br /> DEPARTMENT OF PUBLIC WORKS <br /> P.O.BOX 1810- 1.810 E.HAZELTON AVENUE Deputy Director <br /> STOCKTON,CALIFORNIA 95205 FRITZ BUCHMAN <br /> THOMAS GAU (209)468-3000 FAX(209)468-9324 Deputy Director <br /> Director Nii1Vw.SjgOV.Org/pubworkS <br /> ROGER JANES <br /> Business Administrator <br /> BUILDING PERMIT APPLICATION CLEARANCE FORM <br /> PS-1300602 <br /> APN 105-040-15 QUAD: NE <br /> SITE ADDRESS: 50ON JACK TONE RDLIND,CA <br /> SETBACK INFORMATION: <br /> Is the building site gear a levee or watereourse:N <br /> (Project trust be setback 10 feet from the Ievee 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 500 100-Year Flood Information,Elev 0 or Depth 0 <br /> 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. EIevation Certifcation. <br /> nX 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 DRIYEIVAY ONLY: <br /> F] Paved or Concrete.Drive;vay(s)required prior lofinal occupancy: I acknotivledge the Driveivay(s)ivill be paved as <br /> required by the Encroachment Permit(EPfnd inspected by the Department of Public Worksprior to the Final Building Inspection. <br /> A TEMPORARY GRAVEL DRIVEW Yr PROACH SHALL BE CONSTRUCTED PRIOR TO STARTING BUILDING CONSTRUCTION. <br /> nI acknowledge that the existing drive ay i paved with Concrete or Asphalt Concrete,therefore an Encroachment Permit <br /> (EP)is not required. <br /> Not Applicable r� j <br /> APPLICANT SIGNATURE-TITLE: DATE: <br /> REVIE«'EDB) <br /> This form determines flood elevation zones and allows planc eking only. I acknowledge that all Public Works Conditions of Approval for the <br /> project(PS-1300602)shall be satisfied. The conditions of pproval may take time to process and delay release of Public Works approval,therefore <br /> Initiate processing of the Conditions as soon as possi le <br /> APPLICANT SIGNATURE-TITLE: DATE: `� ' <br />