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APPLICATION- SITE APPROVAL <br /> PRIVATE RIGHT OF WAY- ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> SITE IMPROVEMENTS AND SERVICES <br /> Waiter <br /> Public Water Service Provider Annex-Formation Distance to Public Water <br /> Proposed❑ Required (Feet) <br /> Existing❑ <br /> Private Water❑ Existing Well ❑ New Well Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Service Provider Annex-Formation Distance to Public Sewer <br /> Disposal Required Facility <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewage Existing Septic System ❑ New Septic System 4Other ❑ <br /> Disposal❑ <br /> Storm Drainage <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Required to: Ponds <br /> Proposed❑ <br /> Existing❑ <br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change X Other ❑ <br /> Drainage❑ <br /> Electricity Telephone Servico <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> -� <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem Service Provider Distance to Fire <br /> School Station <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> 2 ( Yes❑ No Yes❑ No' <br /> Yes❑ No CK Yes❑ No <br /> -3- <br />