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APPLICATION - DEVIATION <br /> ch '_1_1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> c <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 /> IF__06Tnsi,te Sewage <br /> Disposal Existing Septic System ❑ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> e <br /> Draina Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage <br /> Proposed ❑ Required to: Ponds <br /> Existing ❑ <br /> Private Storm <br /> Draina e On-site Retention Pond(s) ElNatural Drainage/No Change [ ( Other El <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> Pe- .t F _'Sc -4, Y_ SP,CJ A r# T 50 f+ �1 <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> L-cd,t L�l1i�11(L- /11� e� Ll+'1C r� �l 1't?i Ali <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F\DEVSVC\Plannino Application Forms\Deviation doc (Revised 1-6-03 Page 3 of 6 <br />