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APPLICATION - DEVIATION <br /> Q.` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r. FILE NUMBER: DV- <br /> �/FORH <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Proposed❑ Required Water Feet <br /> Existin ❑ <br /> Private Water.{ Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> jDisosal <br /> Annex-Formation Distance to Public <br /> Service Provider Required Sewer Facilitv <br /> Existing Septic System Y 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 /> Draina a 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 /> School Service Fire Protection Service <br /> Service Provider Distance to Elemyyre,,,.4r� <br /> School Service Provider Distance to Fire Station <br /> L tjp&m U t e j L /SOU r WaT — OrLhp 1 <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> (, r Yes❑ Nolgr Yes❑ No <br /> Yes❑ No❑ Yes ❑ No❑ <br /> F:\DEVSM131annin0 Application Forms\Deviation.doc.(Revised 5-11-09) Page 3 of 6 <br />