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J + <br /> DI ON MIN I <br /> .....:. '::::; `;: :;?i:::;;:::::1:>::::::i;:: i''•is:'2i:%C%;i:::ii:%i:;`:i::::i::::::;:.;.;,:;»::..:.>::. <br /> 'VYATF <br /> Service Provider: Annexation or Formation Distance to Public Water(R) <br /> Public Water Required? <br /> Existing C•AC w A TtZ <br /> Yes ❑ No ❑^ <br /> Proposed <br /> Existing Well ❑ New Well ❑ Other: <br /> Private Water: B <br /> .............. <br /> ... ..:. i':.Y:,:•i:t•,�::::�:;:...::vn.:•:•....:.:...:.:......ii:,:is?:ti�.iii:i;:y. ..:........:. <br /> Public Sewage Disposal Service Provider: Annexation or Formation Distance to Public Sewer <br /> Required? Facility(miles) <br /> Existing ❑ <br /> proposed <br /> ❑ Yes❑ No <br /> ❑ <br /> On-Site Sewage Disposal: Existing Septic System New Septic System <br /> Other: <br /> <%;<i? i?`i�'.<i �iii'iE �i"�`?%i J`ii( ii i ,•';?%?'r';i%:•r';<ifi,'`1: ?'#iiii`iii;ji'i;`i�:r:i;2;:;:;::;:::;:4:::: :;y;i;:;:•;>is:'i::::<.iii>i::<: <br /> Public Storm Drainage Service Provider: Annex or Formatior Terminal Drainage to: Detention- <br /> Required? Retention Ponds? <br /> Existing ❑ Yes❑ No <br /> Proposed ❑ Yes[I No❑ <br /> Private Storm Ot}1er: <br /> Drainage: On-site Retention Pond(s) ❑ <br /> Natural Drainage/No Change .J <br /> . .. ........... <br /> .:. ..TELEPHONE$ERV.:.,, <br /> Service: <br /> Service Provider: <br /> Distance to Service: <br /> Service Provider: Distance to Se <br /> QAGIFhC: D ✓ llt <br /> .... : ....... . <br /> FIRL. RQ'` CTXON SES .... ......... ........ <br /> Distance to School Service Provider <br /> Dist..to Fire Station <br /> District <br /> Elementary: <br /> Hieh School: <br /> =EX7S:TXSG;AGCES ;R.QA_,. ...... ........ :.;::....::,..ii; ::..:.i.:>•:..;.;:;::..;:<:.::i;:::;i:.>;:;.;.:::.;::..:; :.<:::i;::.;:.;::.;::.:.::.i;:.;;;::.::.i.:..::::::::.:::..... <br /> Road/Street Name R.O.W.Width Pavement Wry Curb/Gutter Sidewalks <br /> �,✓�' ? Gil�� Qv r Yes❑ No❑ Yes❑ No❑ <br /> FvL70 ,t/ T <br /> tiV Yes❑ No❑ Yes❑ No❑ <br /> r <br />