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PLAN MAP AMENDMENT ' <br /> 2'' tri 4 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c. . FILE NUMBER: - - <br /> 9��FOR� <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider <br /> Required- Water Feet <br /> Proposed Ll <br /> Existing <br /> Private Water 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 /> On-site Sewage <br /> Disposal Existing Septic System New Septic System ❑ Other ❑ <br /> Stone 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 Stone <br /> Draina a ja 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 /> 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 Pavement Width Curb/Gutter _Sidewalks <br /> ( Z Z? Yes ❑ No N Yes❑ No <br /> Yes ❑ No❑ Yes❑ No❑ <br /> ENVIRONMENTAL INFORMATION <br /> (USE ADDITIONAL PAPER IF NECESSARY)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 /> D Aj S <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 /> Q AJ i� <br /> F:\DEVSVC\Planning Applicalion Forms\ Page 5 of 7 <br /> Plan Application AmendmenLdoc.(Revised 05-11-09 <br />