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3 f <br /> APPLICAT16 -=.DEV.IATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT K <br /> y <br /> Service Provider Annex-Formation Distance to Public <br /> Public Water Required Water(Feet) <br /> Existing <br /> Proposed ❑ <br /> Prlvate Water❑ Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> �Y <br /> Public Sewage Service Provider Annear-Formation Distance to Public <br /> Disposal Required Sewer Facility <br /> Existing ❑ <br /> Proposed ❑ <br /> On-site Sewage Existing Septic System p New Septic System Other ❑ <br /> Disposal O py <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detention- <br /> Drainage Required to: Retention Ponds <br /> Existing p <br /> Proposed O <br /> Private Storm On-site Retention Ponds) ❑ Natural Drainage/No Change V,-' Other p <br /> Drainage❑ <br /> _ � &w' - 18Ctilli1S i1 ewSery <br /> Service Provider Distance to Service Provider Distance to <br /> Service Service <br /> Me, <br /> Service Provider Distance to Elem Service Provider Distance to Fire <br /> School Station <br /> r' h <br /> ,. -$ = gam^rt <br /> Road(Street Name R.O.W, Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> -3- <br />