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APPLICATION - SITE APPROVAL <br /> Q` Z� PRIVATE RIGHT OF WAY — ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> A�rFORN <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed rl <br /> Existinc <br /> Private Water Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Existin ❑ J/✓L- <br /> On-site Sewage <br /> Disposal❑ Existing Septic System ❑ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing❑ /'&N <br /> Private Storm <br /> Drainage❑ On-site Retention Ponds ❑ Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> p <br /> / C7 i L- 74 S,t-C r 14 74-S r 7`—e <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> /61 8e 0 2 al!les l/u Ilee dan e 2 In iYeS" <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> ee J o q d 40 — Z Z Yes❑ No& Yes❑ Nom] <br /> Yes❑ No❑ Yes❑ No❑ <br /> F:\DEVSVC\Planning Application Forms\Site Approval) Page 3 of 7 <br /> Private Right of Way.(Revised5-11-09 <br />