SU0010155 - Laserfiche WebLink

Home Browse Search

LAME Water Public Water Service Provider Ann;.-x-Formation Distance to Public Proposed O 17equired Water(Feet) FFExisting X Mountain House Community Services District None On-Site Private Water O Existing Well O New Well O Well Replacement O Sewage Disposal Public Sewage Service Provider Annex-Formation Distance to Public Disposal Required Sewer Facility Proposed O Existing X Mountain House Community Services District None On-Site On-site Sewage Existing Septic System O New Septic System O Other O Disposal1 Storm Drainage Public Storm Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention Proposed O Required to: Ponds Existing O Mountain House Community None Public Storm None Services District Drain System Private Storm Drainage On-site Retention Pond(s) O Natural Drainage/No Change O Other O O Electricity Natural Gas Service Provider Distance to Service Service Provider Distance to Service Modesto Irrigation District On-Site PG&E On-Site School Service Fire Protection Service Service Provider Distance to Elem Service Provider Distance to Fire Station School Lammersville Unified School District 2,000' Tracy Fire 2,000' Existing Roads Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks Yes X No O Yes X No O Walcott Avenue 62' 41' Yes X No O Yes O No X Langord Drive (Private) 30'PRE 22' Yes X No O Yes X No O Huntington Avenue 54' 38' Yes X No a Yes O No X Unnamed Road (Private) 30'PRE 22' Proposed Roads Sidewalks Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Yes[7 No O Yes O No O Yes O No O Yes O No O AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 1, the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents, officers and employees from any claim,action or proceeding against the Owner/Agent's project. 1, further, certify under penalty of perjury that 1 am(check one): E[ Legal property owner(owner includes partner, trustee, trustor,or corporate officer)of the property(s) involved in this application,or 0 Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf) and that the foregoing application statements are true and correct. Print Name: L —c ct�I"adv Signature: J --� --, Date:-7/II 1`/ Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Si nature: Date: