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APPLICATION - VARIANCE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: VR- <br /> GiFORN <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> PrivateWaterM Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Ann tion Distance to Public <br /> Disposal Service Provider Re uired Sewer Facili <br /> Proposed ❑ <br /> Existin ❑ <br /> On-site Se a e <br /> Disposal Existing Septic System New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(if Public) 9 <br /> Proposed ❑ Required to: Ponds <br /> Existing ❑ <br /> Private St <br /> or <br /> Draina a On-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider I 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 /> �nl t 1 UfJIP1�D �Z )vt1LE WA—FE-R-t <br /> Existin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutte7r�,r Sidewalks <br /> =Z pp El 15, 241 Yes No Yes❑ Q4 <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> FADEVSMPlanning Application FormsWanance.dm.(Revised 5-11-09) Page 3 of 7 <br />