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T•�A.c APPLICATION - ZONE RECLASSIFICATION <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: ZR- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water❑ Service Provider Required Water Feet <br /> Private Water x❑ Existing Well x❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Annex-Formation Distance to Public <br /> Public Sewage Service Provider Required Sewer Facility <br /> Disposal ❑ <br /> On-site Sewage Disposal ❑ Existing Septic System x❑ New Setic S stem ❑ Other ❑ <br /> Storm Drainage <br /> Annex-Formation Terminal Detention- <br /> Public Storm Service Provider Required Drainage to: Retention Ponds <br /> Drainage❑ <br /> Private Storm Drainage❑ On-site Retention Ponds x❑ Natural Drainage/No Chane x❑ Other ❑ <br /> Electricity Natural Gas <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> P.G.E. On site P.G.E. On site <br /> Telephone Service Cable Television Service <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> on site On site <br /> A.T.T. satellite <br /> School Service Fire Protection Service <br /> Distance to Elem. Distance to Fire <br /> Service Provider School Service Provider Station <br /> Escalon Unified '/<mile Escalon Fire Dept. 1A mile <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Escalon Bellota Road Yes ❑ No x❑ Yes❑ No x❑ <br /> Yes❑ No❑ Yes ❑ No❑ <br /> F tDEVSV&Planning Application Forms\ZONE RECLASSIFICATION Page 3 of 5 <br /> (Rev.05-11-09) <br />