Laserfiche WebLink
h � <br /> r4UiN. APPLICATI N --- DEVIATION <br /> ),' I•.OG <br /> y f SAN J.OAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` FILE NUMBER: DV- <br /> �r � �� � ! -' r" '- rY#KOt � ,..t . , U rx �..�vb'.�t� •_:f t.���� ai `a r ,yam <br /> : i <br /> Annex formation Distance to Public <br /> Public Water Service Provider Required- <br /> Proposed <br /> e uiredProposed❑ <br /> Existing,❑. <br /> Private Water Existing Well <br /> .. W e � <br /> New Well ❑ Well Re lacem nk ❑ <br /> Se>vage l7isposa# - <br /> Annex-Formation Distance to Public <br /> Public Sewage Service Provider Re uired Sewer Facility <br /> Disposal <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sewage New Septic S ❑ F1Disposal <br /> [� Existing Septic System stere Other @� p Y <br /> Storm lYrai nage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(it Public) Required to: Ponds <br /> Proposed❑ <br /> Existing ❑' <br /> Private Storm Natural Drainage/No Change B— Other ElDraina e❑ On-site Retention Pond(s) El <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elem Service Provider Distance to Fire Station <br /> Service Provider School <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No p ll� Yes❑ Na <br /> Yes ❑ No ❑ Yes❑ No ❑ <br /> F:IDEVSVC1PIanning Application Forms0eviation.dor.(Revised 1-6-03) Page 3 of 6 <br />