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PLAN MAP AMENDMENT <br /> Z' <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .i� <br /> FILE NUMBER: - <br /> 9�iFORa <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> Private Water❑ Existing Well ❑ New Well V 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 /> Dis osal ElExisting Septic System ❑ New Septic System Other E] <br /> Storm Drainage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(if Public) Required to: g Ponds <br /> Proposed F] <br /> Existing❑ <br /> Private Storm <br /> Draina t❑ On-site Retention Pond(s) � Natural Drainage/No Change 50"' Other El <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> d Siff � DSU s�r� <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> h�/rlilGS Axj/_� <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No Rj"_ Yes ❑ No <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 /> N� <br /> Describe the current depth of the ground water and depth to potable water: J,6e-, .otf <br /> Describe any existing drainage courses or eroded areas on or near the project site (e.g. rivers,creeks, swales or drainage ditches): <br /> B <br /> F.\DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Plan Application Amendment doc.(Revised 6-03-04) <br />