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i r <br /> o�.4iln\ <br /> APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public <br /> wer Service Provider Annex-Formation Distance to Public Water(Feet) <br /> Proposed ❑ Required <br /> Existing ❑ - - - <br /> Private WaterJ❑ Existing Well ❑ New Well I7 Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Disposal Annex-Formation <br /> Proposed ❑ Service Provider Required Distance to Public Sewer Facility <br /> Existing ❑ - - - <br /> On-site Sewage <br /> Disposal ❑r Existing Septic System ❑ New Septic System Other ❑ <br /> Storm Drainage <br /> Public Storm Drainage Service Provider(If Public) Annex-Formation Terminal Drainage to: Detention-Retention <br /> Proposed ❑ Required Pontls <br /> Existing ❑ - - - - <br /> Private Storm <br /> On-site Retention Ponds) ❑ Natural Drainage/No Change Other ❑ <br /> Drainage I] <br /> Electricity Telephone Service <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> Pacific Gas & Electric 600 Feet SBC 600 Feet <br /> School Service Fire Protection <br /> Service Provider Distance to Bern School Service Provider Distance to Fire Station <br /> Valley Home School 2 Miles Escalon Fire District 6 Miles <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb Gutter Sidewalks <br /> Henry Road 40 Feet 25 Feet Yes ❑ No 21 Yes ❑ No p <br /> Lone Tree Road 40 Feet 25 Feet Yes ❑ No 2 Yes ❑ No ❑p <br /> Page 3 of 7 <br />