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SM-J0AQU1N COMMUNITY DEVELOPMENT-DEPARTMENT <br /> COUNTY MOUNTAIN HOUSE <br /> crr<icncss _qrr,r,s herr, PLAN AND DEVELOPMENT TITLE <br /> APPLICATION/AMENDMENT <br /> FILE NUMBER: <br /> PROPERTY SITE IMPROVEMENTS AND SERVICES <br /> Wafer <br /> Public Service Provider: Will Serve Letter Provided Distance to Public Water: <br /> o MHCSD o 0' <br /> Private Existing Well New Well Well Replacement <br /> ❑ ❑ ❑ ❑ <br /> Wastewater Disposal <br /> Public Service Provider: Will Serve Letter Provided Distance to Public Sewer: <br /> o MHCSD o 0' <br /> Private Existing Septic System New Septic System Septic System Replacement <br /> ❑ ❑ ❑ ❑ <br /> Storm Drainage <br /> Public Service Provider: Will Serve Letter Provided Distance to Public Storm Drain: <br /> o MHCSD a 0' <br /> Private Existing On-site Retention Pond New On-site Retention Pond Natural Drainage <br /> ❑ ❑ ❑ ❑ <br /> Electricity Telephone Service <br /> Service Provider: Distance to Service: Service Provider: Distance to Service: <br /> MID 0' AT&T 0' <br /> Fire Protection Service <br /> Service Provider: Distance to Fire Station: <br /> MHCSD 1 French Camp Fire F.D. <br /> School Service <br /> District: - Distance to School- <br /> Elementary:LUSD <br /> High School: <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Guttor Sidewalks <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes ❑ No❑ <br /> Page 4 of 7 <br />