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-R.-PROPOSFD PARCELS <br />Parcel Number <br />'- Existing or Proposed Use of Parcel ~ <br />Square Footage <br />or Acreage <br />u< C_22E _ <br />t 6 4L - <br />SITE IMPROVEMENTS AND SERVICES <br />Water <br />Public Water <br />Existing o <br />Proposed o <br />Service Provider <br />Annex -Formation <br />Required <br />Distance to Public Water <br />(Feeq <br />Private Water is <br />Existing Well o New Well o Well Replacement o <br />Sewage Disposal <br />Public Sewage <br />Disposal <br />Existing o <br />Proposed o <br />Service Provider <br />Annex -Formation <br />Required <br />Distance to Public Sewer <br />Facility <br />On-site Sewage <br />Dis oral <br />Existing Septic System o New Septic System o Other o <br />Storm Drainage <br />Public Storm <br />Drainage <br />Existing o <br />Proposed o <br />Service Provider <br />Annex -Formation <br />Required <br />Terminal Drainage <br />to: <br />Detention -Retention Ponds <br />Private Storm <br />Drainage <br />On-site Retention Pond(s) o <br />Natural Drainaga No Change 0 Other o <br />Electricity <br />Natural Gas <br />Service Provider <br />Distance to <br />Service <br />Service Provider <br />Distance to Service <br />`JB I <br />1,16 <br />Tele hone Service <br />Cable Television Service <br />Service Provider <br />Distance to <br />Service <br />Service Provider <br />Distance to Service <br />S(56, <br />School Service <br />Fire Protection Service <br />Service Provider <br />Distance to Elem <br />School <br />Service Provider <br />Distance to Fire Station <br />�^ <br />A N.\Y �f2— 0 l " <br />nig Li— <br />Existing <br />Roads <br />Road/Street Name <br />R.O.W. Width <br />Pavement Width <br />CurWGutter <br />Sidewalks <br />Yes o No o <br />Yes o No o <br />Yes o No o <br />Yes o No o <br />Proposed <br />Roads <br />Road/Street Name <br />R.O.W. Width <br />Pavement Width <br />Curb/Gutter <br />Sidewalks <br />Yes o No o <br />Yes o No o <br />Yes o .No 0 Yes o No c <br />