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oAa�'y. APPLICATION --SITE APPROVAL <br /> �.• �t�o <br /> "y PRIVATE RIGHT OF WAY — ANTIQUATED SUBDIVISION <br /> �'•� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> \9'••....`••NSP <br /> ,FOR <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existing ❑ <br /> Private Waterz Existing Well ❑ New Well Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re uired Sewer Facility <br /> Proposed ❑ <br /> Existing ❑ <br /> On-site Sewage <br /> DisposalDisposal3a Existing Septic System ❑ New Septic System XOther ❑ <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 Stor <br /> Draina e On-site Retention Ponds ❑ Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> 30C) C) C) <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> C.SLa tcv�_ S C c <br /> L °� r o � l: �, Les <br /> Existing Roads <br /> / Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> ! ` <br /> cj Yes ❑ No Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F:\DEVSVC\Planning Application Forms\Site Approval) Page 3 of 7 <br /> Privata Rinht of Wav rR­AfA_9_n 1 <br />