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PROJECT INFORMATION <br /> Please provide project-related information for the following questions: <br /> 1. Do the proposed boundaries create an island of non-agency territory? [] Yes [] No <br /> 2. Do the proposed boundaries split lines of assessment or ownership? [] Yes [] No <br /> 3. Does the proposal involve public rights-of-way or easements? [] Yes [] No <br /> 4. Does the proposal involve public land or land assessed by the State? [] Yes [] No <br /> 5. Does any part of the proposal involve land under a Williamson Act [] Yes [] No <br /> Contract or Farmland Security Zone? <br /> 6. Does any part of the proposal involve land with a Wildlife/Habitat [] Yes [] No <br /> Easement or Agricultural Land Conservation Easement? <br /> 7. List the affected Assessor Parcel Numbers, Owners of record and Parcel Sizes: <br /> APN Owner Acreage <br /> (Attach a separate sheet if necessary) <br /> 8. Physical Location of Proposal: <br /> (Street or Road, distance from and name of Cross Street; quadrant of City) <br /> 9. Has an application been filed for an underlying project (such as Development Plan, <br /> Conditional Use Permit, or Tentative Subdivision Map)? [ ]Yes [ ] No <br /> If Yes, please attach a Project Site Plan or Tentative Subdivision Map. <br /> If No, please provide an estimate of when development will occur: <br /> 10. List those public services or facilities which will be provided to the affected territory as a result <br /> of the proposed action: <br /> 11. Indicate which of these services or facilities will require mainline extensions or facility up- <br /> grades in order to serve the affected territory: <br /> 12. Provide any other justification that will assist the Commission in reviewing the merits of this <br /> request. (Attach a separate sheet if necessary) <br /> Justification of Proposal Revised:6-3-10 Page 2 of 3 <br />