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2' <br /> APPLICATION - VARIANCE <br /> w < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .. ;� FILE NUMBER: VR- <br /> 4�'ii;a <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existing ❑ <br /> Private Water Existing Well Rr New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ . <br /> EAsting ❑ <br /> On-site Sewage <br /> Dis osa[Q Existing Septic System New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(if Public) Required to: Ponds <br /> Proposed❑ <br /> Existing 21D191 <br /> Private Storm <br /> Drainage❑ I On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem Service Provider Distance to Fire Station <br /> School <br /> Za <br /> Existing Roads <br /> Road/Street Name R.Q.W.Width Pavement Width Curb/Gutter Sidewalks <br /> c) YMYes ❑ No EK Yes❑ Not& <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> FADEVSVCTIanning Application FormsWariance.doc.(Revised 8-18-04) Page 3 of 7 <br />