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A4U1" APPLICJ ION - VARIANCE <br /> Q, SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . `P.. FILE NUMBER: VR- <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❑ 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❑ N <br /> On-site Sewage <br /> Dis osal❑ Existing Septic System [jNew Septic System E] Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Ann <br /> Drainage Service Provider(if Public) ex Formation Terminal Drainage Detention-Retention <br /> Required to: Ponds <br /> Proposed 1-1 <br /> Existing❑ <br /> Private Storm <br /> Draina e❑ On-site Retention Pond(s) El Natural Drainage/No Change E] Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> b £ A- <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> /N✓_ <br /> Existing Roads <br /> Road/Street Name R-0 W.Width Pavement Width Curb/Gutter Sidewalks <br /> p ,.-"y► Yes ❑ No R�� Yes ❑ No[jam <br /> Yes ❑ No 9/ Yes ❑ No <br /> F\DEVSVC\Planning Application Forms\Variance.doc.(Revised 5-11-09) Page 3 of 7 <br />