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°A4UtN. APPLICA , ION - VARIANCE <br /> ¢' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �q•..,• :•..•�P FILE NUMBER: VR- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Wate <br /> Public Water Service Pro <br /> Annex-Formation Distance to Public <br /> ' er <br /> Proposed❑ Required Water Feet <br /> Existing ❑ <br /> Fj7Private Water❑ Exis g Well ❑ New Well ❑ Well Replacement ❑ <br /> Sewage isposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Servic rovider Required Sewer Facili <br /> Proposed E] <br /> Existin <br /> On-site Sewage <br /> Disposal❑ Existing Septic System ❑ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Publi Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing ❑ ter <br /> Private Storm <br /> Draina e❑ n-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Servi e Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name 2 R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 2 LA S, �L y ��'r Yes ❑ No Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No❑ <br /> F:\DEVSVC\Planning Application Forms\Variance.doc-(Revised 8-18-04) Page 3 of 7 <br />