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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 Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> Private Water Existing Well New Well Well Re lacement ❑ <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 Sewage <br /> Dsi oSe Existing Septic System New Septic System Other ❑ <br /> Storm Drainage <br /> Public Storm e Detention-Retention Annex-Formation Terminal Drainage Drainage Service Provider(if Public) 9 <br /> Proposed ❑ <br /> Required to: Ponds <br /> Existing ❑ <br /> Private Storm <br /> Drainage 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 /> PG -4 E 5o-4. Y- SU, A r-4-T 56 f+. '1— <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 /> &yz SS oL.�, Yes ❑ No Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F\DEVSVCPIanning Application Formszeviation.doc.(Revised 1-6-03) Page 3 of 6 <br />