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if �/�q ®ON VARIANCE ' <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c �P FILE NUMBER: VR- <br /> SITE IMPROVEMENTS <br /> R- <br /> SITEIMPRDUEMENTS AND'SERVIGES <br /> 'Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Rec 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 Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Existin ❑ <br /> On-site Sewage <br /> Disposal ElExisting Septic System ElNew 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 ❑ <br /> Private Storm <br /> Drainage ❑ On-site Retention Pond(s) ❑ Natural Drainage/No Change [2 Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> PG&E at site SBC at site <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Lodi Unified Woodbridge Fire <br /> Existing Roads <br /> Road/Street Name R.O.W.Width I Pavement Width Curb/Gutter Sidewalks <br /> Highway 12 (Terminous Road County Standards Yes[I No[y� Yes ❑ No ff] <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> FADEVSVC\Planning Application Forms\Variance.doc.(Revised 8-18-04) Page 3 of 7 <br />