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I <br /> -- <br /> ° c� APPLICATIUN — DEVIATION <br /> y < <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> �1Fdr�� <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 New Well Well Replacement ❑ <br /> Sewage Dispcsal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <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❑ I Required to: Ponds <br /> Existing ❑ <br /> Private Stor <br /> Draina a 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 /> jlvgilae Prov! School <br /> r Distance to Elem Service Provider Distance to Fire Station <br /> r � eek <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> /1 Q Ye No❑ Yes❑ No <br /> Yes ❑ No ❑ Yes ❑ No <br /> FWEVSVOPlanning Application For sDevialion.doc.(Revised 18-03) Page 3 of 6 <br />