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APPLICAON - DEVIATION <br /> ?. y <br /> `r SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `a FILE NUMBER: DV- <br /> c1a6,t.+ <br /> SITE IMPROVEMENTS AND SERVICES <br /> -== —Water== - <br /> _._.— , ,. <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed❑ - � <br /> TAX- <br /> Existing ❑ <br /> Private Water❑ Existing Well NQ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re aired Sewer Facility <br /> Proposed ❑ <br /> Existing ❑ <br /> On-site Sewa <br /> Disposal f Existing Septic System New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation L71al Drainage Detention-Retention <br /> Required to: Ponds <br /> Proposed E] <br /> Existing ❑ <br /> Private Storm <br /> Draina a On-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Intern Service Provider School Service Provider Distance to Fire Station <br /> rh <br /> Existing Roads <br /> Road/Street Name R.O.W. Width I Pavement Width Curb/Gutter Sidewalks <br /> 5 Yes ❑ No X Yes ❑ No <br /> Yes❑ No ❑ Yes❑ No❑ <br /> FiDEVSVMPlanning Application Foms0eviation.doc.(Revised 1-6-03) Page 3 of 6 <br />