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P4urN APPLICATION - DEVIATION <br /> r.' <br /> w < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4c< N r FILE NUMBER: DV- <br /> 0 <br /> SITE IMPROVEMENTS AND SERVICES <br /> _Water <br /> Ann tion Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed ❑ <br /> Existing❑ <br /> Private Water Existin Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Ann tion Distanceto Public <br /> Disposal Service Provider Re uired Sewer Facility <br /> Proposed[a <br /> Existin 'C3 <br /> On-site See <br /> Dis osalws Existing Septic System t 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 /> Private Storm <br /> Drainage❑ On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> Mill ON St's ATT CK SIM <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> QSCALoN S n 3✓n l lei W SGAccN <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> FtIVE J20RG (p0 �� Yes❑ No Yes❑ NoA <br /> Yes❑ No❑ Yes❑ No❑ <br /> FADEMMPlanning Application Fa ms0eviation.doc.(Revised 5-11-09) Page 3 of 6 <br />