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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 /> Existing ❑ C-4 IFcao.1,04 'J?i G2 <br /> Private Water Lj Existing Well New Well ❑ Well Re lacement El <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Reguired Sewer Facility <br /> Proposed ❑ _ <br /> Existing ❑ t=,9 ST STcaLKTo 5 5 P <br /> On-sisite Sewage <br /> Disposal e ❑ Existing Septic System r_7 New Septic System E] Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Annex Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(if Public) <br /> Required to: Ponds <br /> Proposed ❑ <br /> Existing ❑ Npr/E <br /> Private Storm <br /> Private <br /> ❑ 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 /> SEWQ AT i i <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> STockToW UINIP1ED El;—, 510E <br /> Existing Roads <br /> Road, <br /> Street Name R.O.W. Width Pavement Width Curb!Gutter Sidewalks <br /> TvTre - ✓ ZS 5c7 Yes ❑ Non Yes ❑ No?1 <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F 1DEVSVCkPIanrwng Application FormslDeviation.doc (Revised 6-03-04) Page 3 of 6 <br />