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APPLICATION - DEVIATION <br /> ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed❑ <br /> Existing❑ <br /> [—private Waterk Existing Well 19New 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 See <br /> Disposal Existing Septic System New Septic System El 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 /> Drainage" On-site Retention Pond(s) ❑ Natural Drainage/No Change 10 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 ElemSchool Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> y(-I ❑ No N Yes ❑ No <br /> Li4e_ Gard Yes❑ No [$ Yes E] No <br /> \DEVSVC\Planning Application Forms\DeviaGon.doc.(Revised 1-6-03) Page 3 of 6 <br />