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oha�ln. PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �`d •:....• '�a FILE NUMBER: - - <br /> �rFOR� <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Annex-Formation Distance to Public <br /> Proposed Service Provider <br /> Pro Required Water(Feet) <br /> P ❑ <br /> Existin ❑ <br /> [—private Water WT Existin 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 /> Existin ❑ <br /> On-site Sew <br /> a <br /> Disposal Existing Septic System New Septic System ❑ Other ❑ <br /> Storm 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 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 /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider � School Service Provider Distance to.Fire Station <br /> �I o �-t ^ M I Pr V <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> S' (S U Yes ❑ No Nr Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No❑ <br /> ENVIRONMENTAL INFORMATION <br /> (USE ADDITIONAL PAPER, IF NECESSARY) <br /> Water, Drainage and Flooding <br /> Descrlbe'any areas subject to flooding (include flood depths and flood panel map number): <br /> S S <br /> Describe A 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.kivers, creeks, swales or drainage ditches): <br /> F.\DEVSVC\Planning Application Forms\ Page 5 of i <br /> Plan Application Amendment doc (Revised 11-05-07 <br />