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SAN J O AQ U I N COMMUNITY DEVELOPMENT DEPARTMENT <br /> ---c o U NT Y DEVIATION <br /> FILE NUMBER: <br /> SERVICES <br /> Water <br /> Public Service Provider: Will Serve Letter Provided Distance to Public Water: <br /> Private Existing Well New Well Well Replacement <br /> Igo ®ice ❑ ❑ <br /> Wastewater Disposal <br /> Public Service Provider: Will Serve Letter Provided Distance to Public Sewer: <br /> ❑ ❑ <br /> Private Existing Septic System New Septic System Septic System Replacement <br /> If the project will result in process Description of process Volume of process wastewater: Method of disposal: <br /> wastewater provide the following wastewater: <br /> information: <br /> Storm Drainage <br /> Public Service Provider: Will Serve Letter Provided Distance to Public Storm Drain: <br /> ❑ ❑ <br /> Private Existing On-site Retention Pond New On-site Retention Pond Natural Drainage <br /> I� ❑ ❑ m� <br /> OTHER PUBLIC SERVICES <br /> School Service Fire Protection Service <br /> Service Provider Distance to School I Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 't Yes ❑ No Yes ❑ No <br /> � _ t <br /> ``541� � f1 �L7f Yes ❑ No Yes ❑ No <br /> Page 2 of 4 <br /> Updated 09/0112020 <br />