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APPLICATION- SITE APPROVAL <br /> PRIVATE RIGHT OF WAY- ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> (4i r 4 t* nI I� e. <br /> SIi`EYIpRO1�EM�N,`IS�AND� <br /> , ry 3r N� <br /> Public Water SeNico Provider Annex-Formation Distance to Public Water <br /> Proposed❑ Required (Feet) <br /> Exisfinglw�, <br /> Private Welobe, Existing Well)X— New Well x Well Replacement ❑ <br /> k ti"Tr! Ott sul{{5 t�j.]1J4�5w}wjy>,ija�q�ff��``'pyy�,�gl y}p 'kth'p' +!tPA7"'o-+t6.1 A:iSMr'kll, �1p ry(' lf�J'yer,.'a�(j{ �yyy' y�'` ,5 <br /> . �1 f.Y t O iVA YI`♦nY>IN� ��-� �r 1`SB WB�er�I5P�s8I,vl4 '{{� II ,`.1.1 1+1 1 11 �'' 1. r ''V,�RTIR <br /> Public Sewage ? i Service Provider Annex-Formation Distance to Public 5ewar <br /> Disposal Required Facility <br /> Proposed❑ <br /> Existing.{ <br /> On-site Sewage Existing Septic System ❑ New Septic System RV_ Other ❑ <br /> Disposat*L <br /> '✓> �w �'"T�.16$t.t- � 3' a` cry � sv rT a-s r�t'r§S5$"NRk,'IAclY?"�}.d HSp p er{a..,. �t'h:f yU'•.1. .,• .,- ,�a.I r y Sfor D>. 9 �x � �. � +�#t ;. �Kit", <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Required to: Ponds <br /> Proposed❑ <br /> Exisling,X_ <br /> Private Storm On-site Retention Pond(s) O Natural Drainage/No ChangeOther ❑ <br /> Drainage <br /> 4' '`n 3y' rt 4 5 r + k3 <br /> i } z a� xt ey� tt r,a u $,, a: <br /> EIBCttlCvlfyT@�woOn�SA/VICO{r��r}4 l <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> 4 ;s,S ° s{ <br /> School$BN/CB 'y i, }'.S f;Y 'P/O <br /> n�, aIY�.� i FII d, t6CflOn'.$BNJCB <br /> Service Provider Distance to Elem Service Provider Distance to Fire <br /> School /Station <br /> i;'121Y1t''/tel ltl/e�.w'gf. ji1 - 4.1+�2+N iNf TbN 4�_ /kr � <br /> { n " <br /> 14 ;1 Klr,1111­111ds c t F 9' `xk&SF aNEr <br /> EX Stlnl <br /> �, ( .,"..r.; <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No Ori Yes❑ No CIL <br /> Yes❑ No P5, Yes❑ No <br />