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C fly. APPLICATION- SITE APPROVAL <br /> PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> io- <br /> FILE NUMBER: SA- <br /> F 6R4k — <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> [ Private Water 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 Sewage <br /> Disposal ® Existing Septic System ❑ 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 e 10 On-site Retention Pond s ❑ Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service ' <br /> Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/GNt <br /> er Sidewalks <br /> Yes ❑ o X Yes ❑ No JK <br /> Yes E] No ❑ Yes ❑ No E7jj <br /> Fi0EVSVCnanning Application Forms\Site Approval) Page 3 of 7 <br /> Private Right of Way.(Revised4-2-03 <br />