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qg N APPLICATION - VARIANCE <br /> Ur SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> c�.. P • FILE NUMBER: VR- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water(Feet) <br /> Proposed <br /> Existin <br /> Private Water❑ Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <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 ElOther E] <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Required to: Ponds <br /> Existingx <br /> Private Storm <br /> Drains t ElOn-site Retention Pond(s) E] o Chan Natural Drainage Other E] <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 14ye Yes ❑ No ❑ Yes ❑ No ❑ <br /> v ,.,•.J �, ,(Jilil.� Yes ❑ No ❑ Yes ❑ No ❑ <br /> F:\DEVSVC\Planning Application Form s\Variance.doc.(Revised 5-11-09) Page 3 of 7 <br />