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Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Requi Sewer Facility <br /> Proposed❑ NA NA NA <br /> Existing❑ <br /> On-site Sewage <br /> Disposal❑X See Existing Septic System El New Septic System C1 Other [3XPro ed Descri tion <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Re wired to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drainage❑X See On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑X <br /> Project Description <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> PGE 1 500 feet SBC 500 feet <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> NA NA None NA <br /> F'\DEVSVC\Planning Application Forms\Use PermH.(Revised 6-03-04) Page 8 of 9 <br />