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°Pg4'M APPLICATION - DEVIATION <br /> x. 3 <br /> a :K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �'° ikiiR���• FILE NUMBER: DV- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Annex-Formation Distance to Public <br /> Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing❑ <br /> Private WaterN1 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 /> Existin ❑ <br /> On-site St�g <br /> Dis osaExisting Septic System $� New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public S <br /> DrainaService Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> ProposeRe uired to: Ponds <br /> Existing <br /> Private Storm <br /> Drainage 10 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 /> G `a7�G�r Ori 5 �G <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fire Station <br /> Ct Or (MI e5chu�) 3 a Z, rn11e-s tE6ccdun Fi tt- W f m, F N dr.4- q v, <br /> Existin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> V ,r• r Yes❑ No C4 Yes❑ No <br /> 4 40 Yes❑ No Yes❑ No <br /> F:\DEVSVC\Planning Application Forms\Deviation.doc. (Revised 5-11-09) Page 4 of 8 <br />