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:e <br /> F APPLICATION- SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> n <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> RM�. . <br /> Public Water` Service Provider Annex-Formation Distance to Public water <br /> Proused <br /> P <br /> (Feat) <br /> Required <br /> t 1 <br /> q <br /> red <br /> Existing❑ <br /> Private Water❑ Existing Well ❑ Now Well Dol Well Replacement ❑ <br /> '. . <br /> Public Sewage Service Provider Annex Formation Dlsfance to Pub!!c Sewer <br /> Disposal Required Facility <br /> Proposed <br /> Existing❑ <br /> On-site Sewage Existing Septic System O New Septic System Other 0 <br /> Disposal 0 <br /> Public Storm Service Provider if Public <br /> Annex_. <br /> l Forma i <br /> ton O , <br /> Terminal <br /> Drainage Detention-Retention <br /> etentrop <br /> Drainage Required <br /> to: <br /> Ponds <br />' Proposed❑ <br /> Existing, <br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑ <br /> Drainage❑ <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> f <br /> rr <br /> Z� O <br /> Service Provider Distance to Elem Service Provr7ler Distance to Fire <br /> School Station <br /> ScYyfJAI <br /> y ,s / <br /> :e° M�Aid' �'`� btu l i 7a s - _[ -ax' �Fk". i � R+iwEX�,.Yef• r�sS I a -..« v4. <br /> Road/Street Name R.0.W. Width Pavement Width Curb/Gutter Sidewalks <br /> a I�dc,T Yes❑ No® "i Yes Q No aOl <br /> Yes❑ No❑ Yes D No[7 <br /> I <br /> 3 <br />