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' APPLICA I rON DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> t'r•F <br /> E ..a3..? t�,d,.< 3.•P'".,„+3' <br /> y [ y,4: <br /> u' i1 f 4r <br /> xis ,.,.�.,,-Sa to R..xn:s._ <br /> i Annex-Formation Distance to Public <br /> Public Water !: Service Provider <br /> Required Water Feet <br /> Proposed❑ I, <br /> Existing ❑ <br /> Private Water " iP Existin ,Weli New well ❑` Well Replacement ❑ <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal k:: Service Provider Required Sewer Facilit <br /> Proposed ❑ <br /> "Existin ❑ <br /> On-site Sewa a <br /> Disposal <br /> I.i6 Existing Septic Systeri� New Septic Systerr) ❑ Other ❑ <br /> Storhi Dri3inage <br /> I Public Storm <br /> Drainage "Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> E Proposed El Required Re uired to: Ponds <br /> Existing ❑ �; <br /> P <br /> iPrivate Storm <br /> Draina e a ;� On-site Retention Pond(s) ❑ Natural Drainage/No Change Other El <br /> Electrrcity Telepfione.Service <br /> i :.. <br /> Distance to <br /> Service Provider i; Service Service Provider Distance to Service <br /> k iGt E_ F..: c,20 ' ICE�, i 13aG , ' <br /> f ;[ School Service 'Fire Protection Service <br /> Provider '` i Distance to Elem <br /> Service <br /> 11.. School Service Provider 2Distance to Fire Station <br />�� a1 O� CV,ewrr,•+o� __5 <br /> Existing Roads <br /> rWidth Pavement Width C <br /> i <br /> Road/Street eet Name R.O.W.R.O W W d urb/Gutter Sidewalks <br /> i <br /> CN SC? Yes❑ No D Yes ❑ NoX <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> I` <br /> :i <br /> o <br /> F:10EV5VCIPlanning Application Forms'y eviation.doc.(Revised 4-6-03) -.Page 3 of 6 <br />