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APPLICATION - DEVIATION <br /> L. <br /> e' < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t* FILE NUMBER: DV- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existing❑ <br /> Private Water Existin Well � New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facili <br /> Proposed ❑ <br /> Existing❑ <br /> On-site Sewage <br /> Disposal[9- 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 /> Existing❑ <br /> PrivateStorm <br /> Drama= On-site Retention Pond(s) �!F Natural Drainage/No Change K Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> 6 �c:- jpN,SiTte aN- 5 /TE <br /> School Service Fire Protection Service <br /> Service Provider Distance to Earn Service Provider Distance to Fire Station <br /> School <br /> */, 7- <br /> Existing <br /> Existin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 1/ Yes El M Yes E]El <br /> �/Le�,�--bC Z Yes ElNo[a- Yes❑ No Est, <br /> FADEVSVC1PIann1ng Application Forms\Deviation.dm.(Revised 5-11-09) Page 3 of 6 <br />