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�pulN <br /> APPLICATION - DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �gt;F-o •a P 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-JR <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 <br /> On-site Sewage <br /> Disposal ❑ Existing Septic System ❑ New Septic Systerrt ElOther ❑ <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 ❑ <br /> Private Storm R--"Draina e ElOn-siteRetention Pond(s) El Natural Drainage/No Change R Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> G 4- — A 1-4-1 <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 0p r Yes ❑ No Yes ❑ No <br /> Yes ❑ No Yes ❑ No <br /> FZM- <br /> F:\DEVSVCkPlanning Application Form s\Deviation.doc.(Revised 1-6-03) Page 3 of 6 <br />