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.y APPLICAON <br /> y' VARIAN�;E <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: VR- <br /> u `�s f1PR!?/E1111 1r,S/k �s R CES 4 <br /> 41 <br /> Public Water <br /> Proposed <br /> Service Provider Arinex-Formation Distance to Public <br /> ❑ <br /> Existin .❑ Re uired Water Feet <br /> Private Water Existm Well <br /> New Well <br /> Well Replacement ❑ <br /> •. -. Sejn►age 15ispb3�l _ <br /> Public Sewage <br /> Disposal Service Provider <br /> Annex-Formation Distance to Public <br /> Proposed❑ Re Ore-d Sewer Facill <br /> Existin ❑ <br /> On-site Se age <br /> Dis osa Existing Septic System New Septic System ❑ Other <br /> It Dram2ige <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage <br /> Proposed Detention-Retention <br /> ❑ Re uired <br /> Existing❑ to Ponds <br /> Private torm <br /> Draina On-site Retention Pond(s) ❑ Natural Drainage/No Change Other <br /> Electricity <br /> Telephone Service <br /> Service Provider Distance to <br /> Service Service Provider Distance to Service <br /> School Seryice Fire Protection Service <br /> Service Provider Distance to Elem <br /> h <br /> ZSchool Service Provider Distance to Fire Station,5 1 . <br /> 5 4, <br /> Existing Roads <br /> Road/Street Name R.O.W.Width h Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No Yes❑ No, <br /> Yes❑ No❑ Yes ❑ No❑ <br /> rMEVSVOPIanning Application FormsSVariance.doc. (Revised 8-18-04) Page 3 of 7 <br />