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° A°`" ' �'• APPLICATION - Z0101 RECLASSIFICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO : ZR- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water (� Service Provider Required Water Feet <br /> Private Water ❑ Existing Well ElNew Well ElWell Replacement ❑ <br /> Sewage Disposal . <br /> Annex- Formation Distance to Public <br /> Public Sewage Service Provider Required Sewer Facility <br /> Disposal 2' L j % % d Aj5 , 4e T <br /> On -site Sewage Dis osal El Existing Septic System ❑ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Annex-Formation Terminal Detention- <br /> Public Storm Service Provider Required Drainage to . Retention Ponds <br /> Drainage Ga' C.. � 'c � c� � �t' ac-C�'iba� W � ��Jr • <br /> Private Storm Drainage ❑ On -site Retention Ponds ❑ Natural Drainage/No Chane ❑ Other ❑ <br /> Electricity Natural Gas <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> Telephone Service Cable Television Service <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> Ld u%%% CAXNqT <br /> School Service Fire Protection Service <br /> Distance to Elem . Distance to Fire <br /> Service Provider School Service Provider Station <br /> Existing Roads <br /> Road/Street Name R . O .W . Width Pavement Width Curb/Gutter Sidewalks <br /> sm khN a Cion - k% I+% �o ` Yes ❑ No 's Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F :\DEVSVS\Planning Application Forms\ZONE RECLASSIFICATION Page 3 of 5 <br /> (Rev . 05A 1 -09) <br />