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APPLICATION - DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> '<') <br /> SITE IMPROVEMENT$AND SERVICES 4:; L•s ,:'t ;_• <br /> water <br /> Public Water Annex-Formation Distance to Public <br /> Service Provider Required Water Feet <br /> Proposed [3a�J o , 9C 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 Systerr) ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(i/Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed C3 Re uired to: Ponds <br /> Existin /Jn {J A <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 /> YesX No ❑ Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F%0EVSv0P1annmg Appkal,on FernlsQLv,ati0n eoC.(Revisea 1-6-03) Page 3 of 6 <br />