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ip <br /> PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existinq❑ <br /> PrivateWaterj5f Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facili <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sew e <br /> Disposal <br /> Existing Septic System New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm Annex-Formation Terminal Draina a Detention-Retention <br /> Drainage Service Provider(if Public) 9 <br /> LpEx1stingr <br /> oposed ElRe uired to: Ponds <br /> Private Storm <br /> Drainage❑ On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> f E 7 '7 <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem Service Provider Distance to Fire Station <br /> School <br /> Existing Roads <br /> Road/Street Name R.O.W.Width I Pavement Width Curb/Gutter Sidewalks <br /> C.,(q Yes❑ No❑ Yes❑ No❑ <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 /> Describe the current depth of the ground water and depth to potable water: <br /> Describe 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 Fonns\ Page 5 of 7 <br /> Plan Application Amendtnent.doc.(Revised 05-11-09 <br />