From there it flows southwest through a canyon to its confluence with the Middle Fork Stanislaus River near Forest Meadows, which forms the Stanislaus River.

The river drains a mountainous, rugged watershed of about 196 square miles (510 km2).

[3] Since the 1980s, the river basin has been extensively developed for hydropower generation.

Water from the North Fork is stored in Alpine, Utica, Union and New Spicer Meadows Reservoirs, which regulate the water supply for McKays Point Diversion Dam, located lower down on the North Fork.

[5] From McKays Point water is diverted to the Collierville Powerhouse, which can generate up to 253 megawatts.