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PROPERTY SITE IMPROVEMENTS AND SERVICES <br /> WATER <br /> Public Water Service Provider: Annexation or Formation Required Distance to Public Water <br /> Existing O Yes O No L7 <br /> Proposed p <br /> Private Water.• Existing Well O New Well O <br /> Other: <br /> SEWAGE DISPOSAL <br /> Public Sewage Disposal Service Provider- Annexation or Formation Required? Distance to Public Sewer <br /> Existing O Yes D No O Facility(miles) <br /> Proposed D <br /> On-Site Sewage Disposal: Existing Septic System D New Septic System D <br /> Other: <br /> STORM DRAINAGE <br /> Public Storm Drainge Service Annexation or Detention-Retention Terminal Drainage to: <br /> Provider.- Formation Required? Ponds? <br /> Existing D Yes O Yes O <br /> Proposed O No O No D <br /> Private Storm Drainage: On-site Retention Pond(s) O Natural Drainage/No Change O <br /> Other. <br /> ELECTRICITY <br /> Service Provider. Distance to Service: <br /> TELEPHONE SERVICE <br /> Service Provider., Distance to Service: <br /> SCHOOL SERVICE <br /> District Distance to School: <br /> Elementary: <br /> High School: <br /> FIRE PROTECTION SERVICE <br /> Service Provider.* Distance to Fire Station: <br /> EXISTING ACCESS ROADS <br /> Road/Street Name R.O.W. Width Curb/Gutter Sidewalks <br /> Pavement Width <br /> Yes O No O Yes O No O <br /> Yes O No O Yes O No O <br /> -4- <br />