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Existing <br /> On-site Sewage <br /> Disposal(X) Existing Septic System New Septic Syste(d(X) Other <br /> Storm Drainage <br /> Public Storm <br /> Drainage Annex-Formation Terminal Drainage to: Detention-Retention <br /> Proposed Service Provider(if Public) Required Ponds <br /> Existing <br /> Private Storm <br /> Drainage On-site Retention Pond(s)(X) Natural Drainage/No Change Other <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> PG & E AT&T <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> F:IDEVSVMPIanning Applica0on FomslSite Approval.(Revis d 02-03-10) Page 6 of 9 <br />