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3 0j <br /> v <br /> APPLICATION - VARIANCE <br /> V?1• P <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: VR- <br /> �r�oa� <br /> SETE IM PROVE MENT$,ANDf66"`C S` <br /> Public Water Service Provider Annex Formation Distance ato <br /> #blit <br /> Proposed ❑ <br /> Existin ❑ <br /> Private Water❑ Existing Well New Well ❑ Well Replacement El <br /> :,.. 5ewage:Dispo;;al <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facilit <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewage <br /> Disposal❑ Existing Septic System New Septic System ❑ Other ❑ <br /> Storm:Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing, ow I <br /> Private Storm <br /> —Drainage❑ 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 /> l <br /> School Service <br /> FireRrofection Semite <br /> I Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> ri <br /> Existin'-,Roads. <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> j d Yes❑ No QSr Yes ❑ No <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> FADFVSMPIanong Application ForrrmsWariance.doc.(Revised 8-18-04) Page 3 of 7 <br />