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1°p4.�.F'•po 1 <br /> APPLICATION - DEVIATION <br /> w < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . :a FILE NUMBER: DV- <br /> FO <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 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 /> Existing❑ <br /> On-site Sewap¢� <br /> Dis osal 0' Existing Septic System 2r New Septic System ❑ Other ❑ <br /> Stone Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Re uired to: Ponds <br /> Existing ❑ <br /> Private Sto <br /> Draina a e 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 /> ,Ja <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem Service Provider Distance to Fin:Station <br /> School <br /> r 6 <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> / Yes❑ No Yes❑ Nolte <br /> Yes❑ No Yes❑ No <br /> F:TEVSVMPlanning Application FoonsTeviafion.doc.(Revised 5-11-09) Page 3 of 6 <br />