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. PLAN MAP AMENDMENT <br /> ?< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - - <br /> �rFOR <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider <br /> Proposed FlRequired Water Feet <br /> Existing❑ <br /> Private WaterNb4 Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Existing ❑ <br /> FOn-site Se e O%U _ <br /> RXT <br /> is osala Existing Septic System ❑ New Septic System ❑ Other <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Required to: Ponds <br /> Existing❑ <br /> Private����On-s�iteRete�ntion <br /> Draina Pond(s) Natural Drainage/No Change ❑ Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> 2s Yes❑ No;!� Yes ❑ NoN <br /> Yes ❑ No Yes ❑ No,© <br /> ENVIRONMENTAL INFORMATION <br /> USE ADDITIONAL PAPER, IF NECESSARY <br /> Water, Drainage and Flooding <br /> Describe any areas subject to flooding (include flood depths and flood panel map number): <br /> C <br /> Describe the current depth of the ground water and depth to potable water: <br /> Des ribe any existing drainage courses or eroded areas on or near the project site(e.g. rivers, creeks, swales or drainage ditches): <br /> F\DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Plan Application Amendment.doc (Revised 11-05-07 <br />