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°p4UtN �- PLAN MAP AMENDMENT <br /> b < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �q, a�P• FILE NUMBER. - - <br /> ��FOR <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ - <br /> Existing 1 -r <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 Facilitv <br /> Proposed❑ <br /> Existing ❑ <br /> On-site Sewage <br /> Disposal❑ I Existing Septic System ❑ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(if Public) Required to: Ponds <br /> Proposed 0 <br /> Existing Elf f� ���,� , <br /> Private Storm <br /> Drainage❑ On-site Retention Pond(s) Natural Drainage/No Change E] Other F] <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider / Service Service Provider Distance to Service <br /> /v" /=r <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> lL/fi <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> / 41 f / % >- Yes ❑ No Yes ❑ No Z1 <br /> Yes ❑ No❑ Yes ❑ No ❑ <br /> ENVIRONMENTAL INFORMATION <br /> USE 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 /> II' A i i, I -n <br /> Describe the current depth of the ground water and depth to potable water: <br /> J7 - IR) 741 <br /> Describe any existing drainage courses or eroded areas on or near the project site(e.g. rivers,creeks,swales or drainage ditches): <br /> F\DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Plan Application Amendment.doc.(Revised 06-03-05) <br />