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f <br /> • . R APPLICATION - VARIANCE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _00-01M 791`011 <br /> a <br /> u . <br /> A <br /> Service Provider Annex-Formation Distance to Public <br /> Public Water Required Water(Feet) <br /> Existing <br /> Proposed O M D e k Imo, H G G�G S 4 In •5: '� <br /> Private Water D Existing Well ❑ New Well ❑ Well Replacement 0 <br /> Q <br /> Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal Required Sewer Facility <br /> Existing <br /> Proposed ❑ W Q d 6f �-r t pF �jQ w.�'�'Q,v S•f D <br /> On-site Sewage Existing Septic System V New Septic System O Other ❑ <br /> Disposal❑ <br /> ON <br /> Public <br /> a' •.' ,�x"`� �'�£- "^'." � •r �° ,r�vC ,�'i - �s � � � fie.... <br /> +'�' ."°"'' <br /> Y <br /> . .<-. <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage] Detention- <br /> Drainage - Required to: Retention Ponds <br /> Existing X +, - � - <br /> Proposed © iii to l�+S'' vet 14 O <br /> a-f kSfia► ZL. • Sari. <br /> Private Storm On-site Retention Pond(s) l7 Natural Drainage/No Change O Other O <br /> Drainage L7 <br /> ,j <br /> wilecblct� S <br /> 4v,r. ''-v-S ..211 <br /> Service Provider Distance to Service Provider Distance to <br /> Service Service <br /> G- G <br /> OLa <br /> f# 8� 'R,i'' <br /> Service Provider Distance to Elem Service Provider Distance to Fire <br /> School Station <br /> i •Z m ; 4c s LJoa�b-r ia� t Fr'rG 'tfi. 4.5 w►;l e - <br /> cr. _ <br /> j Road/SSt+trseet Name R.A.W. Width Pavement Wldth Curb/Gutter Sidewalks <br /> N - ✓d w `7 +G h a Yes No O YesX No Q <br /> Yes 0 No O Yes Q No❑ <br /> Vag;anreappfo[n r.v. 71)2 Jol t4htlf <br /> _3_ <br />