Laserfiche WebLink
LAIME <br /> _ Wufur <br /> Publk Water - S.rvk.Po_ovhi f- Ann.i-Pvrm.Uvn Distance 1.Publ)c <br /> Regtrrnd Watw(F..Q- _ - <br /> Exfarinp <br /> l MHCSD N/A',. ON�-SITE. <br /> Prlvait Warr b�' Eihdn Wert a 'New Wed t?.+�_- Well Re....manf b <br /> Sews a Dis bsal �' <br /> Puolic Sewege Sarvke P7Ovfder - ,Annex.F.Mmlfon Distance go Public ~ <br /> - Disposal - Reguirod - S+War Fecaily <br /> Proposed l _.. - <br /> . Erisring D - - <br /> MHCSD, N/A ON-SITE <br /> On-slro Sewage�'' - Existing Septic System D Now Septic systam D- Odrer D <br /> Dis nsal D ' <br /> Slarm Drains e <br /> Pubfk St—erafnape Service Provider(if Public) Ann-4annoff" Twmlbol Dt+inage Detanfion-Retendon <br /> Propod[j Rpqutnd FM Panels <br /> II Exlatingse9 <br /> MHCSD' N/A OLD RIVER <br /> 3 <br /> PNvare Sfurm orafnsge On-alta RNen don Pond(sJ D Natural Dminag.Wo Change b Other D <br /> b , <br /> - <br /> Elect6citV Natural Gas <br /> Service Provider Distance to Service Service Provider Distance to Servke <br /> MID ON-SITE P.G.&E. ON-SITE <br /> School Service Fire Protection Service <br /> S.rvic+Provider t)ls fanca to Vam S.rvk,Provider Distance to Fire StOicn <br /> School <br /> LAMMERSVILLE SCHOOL c 1 MILE MHCSD / TRACY FIRE 1 MILE <br /> Exist"P Roads <br /> RvardstrBef Name R.O.W.Wfdrh Pavement Width curb/Gutrer Sldvwafks <br /> SANTA CLARA DRIVE 54 38 yes No Ly Yes 10 Nob <br /> Yes D No D Yes D NOD <br /> Proposed Roads <br /> Sidewalks <br /> Ro+d151r.et name R.O,W.Width Pwament Width Cu blGuller <br /> Yes D No D Yes D Ne D <br /> Y..12 No O Yes D No D <br /> AUTHORIZATION SIGNATURES <br /> ONLY TH1:OWNER OF THE PROPERTY OR ANA UTHORIUD AGENT MAY FILE AN APPLICARON. <br /> J,the Owner/Agenf agree,to defend,indemnily,and hold harmless the County and its agents,officers and employees from any <br /> claim,aclioil or proceeding against the OwnerlA gent's project. <br /> 1,furthet, certify under penalty of pei ury that tam{check one): <br /> ❑ Legal property owner(owner includes partner,Trus fee,Trus tot,or corporate officer)of the property(s) <br /> involved in this application,or <br /> Cl Leg of agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf) <br /> and that rhe foregoing application statements are true and correct. <br /> Print Name: Vllj.' Signature: hdT Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />