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' e <br /> NVA i ER <br /> Public Water Service Provider: Annexation or Formation Distance to Public Water(Il.) <br /> P.cquircd7 <br /> Existing ❑ <br /> El <br /> [j No <br /> Proposed ❑ <br /> Private Water: Existing Well New Well Other: -- <br /> SEWAGE DISPOSAL <br /> Public Sewage Disposal Service Provider: Annexation or Formation Distance to Public Sewer <br /> Required? Facility(miles) <br /> Existing � M ✓� <br /> Yes❑ No❑ <br /> Proposed M4 -- <br /> On-Site Sewage Disposal: F.xisiing Septic System Q New Septic System Other:_ <br /> STORM DRAINAGE i <br /> Public Storm Drainage Service Provider: !Annex or Formau"or. Terminal Drainage to:[equ,red? �% Retention Ponds? <br /> Existing <br /> Proposed so ;, C� Yes No- <br /> Private Storm <br /> r� vNo Chane ® <br /> Drainage: On-site Retention Pond(s) L} Naturii Drains g" i; Other:----- <br /> ELECTRICITY. . TELEPHONE SERVICE <br /> Service Provider: Distance to Service: Service Provider. Distance to Service: <br /> rnCrt% CitUi <br /> SCHOOL FIRE PROTECTION SERVICE <br /> District Distance to School Service Pr06der Dist..to Fire Station <br /> Elementary: L�ij vjjv1 `2 Yy 1 <br /> Tom,. / 44 <br /> Hieh School: <br /> EX-STING ACCLSS ROADS. --- <br /> Road Street Name R.O.W.Width Pavement Width Curb.Gutter Sidewalks <br /> r <br /> yes❑ No Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br />