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°A c PLAN IwAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT' <br /> FILE NUMBER: - - <br /> I NSA <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Ex sting❑ <br /> Private Water❑ Existing Well ❑ New Well v Well Replacement ❑ \ <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility— <br /> Proposed <br /> act iProposed❑ <br /> Existing❑ <br /> On-site Sewage <br /> Disposal❑ Existing Septic System ❑ New Septic System Other ❑ <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage DetentiorrR.etention <br /> Proposed❑ Re uired to: Pond$ . <br /> Existing❑ <br /> Private Storm r�,�,� <br /> Drainage ElOn-siteRetention Pond(s) Ng" Natural Drainage/No Change RX' 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 /> l��d yiYl/IGS �T /iyv,C� <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 157yt.716 it L Yes ❑ No Pr 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 /> - ic/d <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 /> F:\DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Plan Application Amendment-doc.(Revised 6-03-44) <br />