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°p4U1N APPLICATION - ZONE RECLASSIFICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water❑ Service Provider Required Water Feet <br /> Private Water® Existing Well Z New Well Z Well Replacement ❑ <br /> Sewage Disposal <br /> Ann tion Distance to Public <br /> Public Sewage Service Provider Re uired Sewer Facility <br /> Disposal❑ <br /> On-site Sewage Disposal® Existing Septic System Z New Septic System Z Other ❑ <br /> Storm Drainage <br /> Annex-FormationTerminal Detention- <br /> Public Storm Service Provider Required Drains a to: Retention Ponds <br /> Drainage❑ <br /> Private Storm Drainage® On-site Retention Ponds ® Natural Drainage/No Chane ❑ Other ❑ <br /> Electricity Natural Gas <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> P.G.&E. Adjacent P.G.&E. Adjacent <br /> Telephone Service Cable Television Service <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> AT&T Adacent Comcast Adjacent <br /> School Service Fire Protection Service <br /> Distance to Elem. Distanceto Fire <br /> Service Provider School Service Provider Station <br /> Lodi Unified Less than 1 Mile Mokelumne 5 Miles <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> State Route 12 80' 36' Yes❑ No Z Yes ❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> F:\DEVSVS\Planning Application Forms\ZONE RECLASSIFICATION Page 3 of 5 Project No. 17110 <br /> (Rev.05-11-09) <br />