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APPLICATI N - DEVIATION <br /> r4 �+ <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> SrrE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing❑ <br /> Private Water Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal <br /> Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewag <br /> Dis sal Existing Septic System New Septic System El Other El <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 Storri}/ <br /> Draina a�( On-site Retention Pons) ❑ Natural Drainage/No Change Other E] <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> ON�I �l <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> L.,!P p l LAPP ` g <br /> ExistingRoads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 2Q Yes❑ No Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> F:\DEVSVC\Planning Application Forms\Deviation.doc.(Revised 6-03-04) Page 3 of 6 <br />