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pa,u,iN <br /> 2.. <br /> APPLICAT iON - DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed El <br /> Existin LAJ u7 to jU (�i L'Gt <br /> Private Water❑ Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formireation Distance to Public <br /> Disposal Service Provider Re ud Sewer Facility <br /> Proposed ❑ <br /> Existing �i Ot J Q l JN <br /> On-site Sewage <br /> Disposal ❑ Existing Septic System ❑ New Septic System! ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Required to: Ponds <br /> Existin <br /> Private Storm <br /> Drainage ❑ 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 /> Service Provider Distance to Elem Service Provider Distance to Fire Station <br /> School <br /> S. <br /> Existing Roads <br /> ` Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> toeo Yesr No❑ Yes ❑ No <br /> Yes❑ No ❑ Yes ❑ No ❑ <br /> F9DEVSMPlanning Application Foms\Devialion.doc.(Revised 1-"3) Page 3 of 6 <br />