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tit, ( � COMMUNITY DEVELOPMENT DEPARTMENT <br /> A _ I - IJ � ADMINISTRATIVE / CONDITIONAL USE PERMIT <br /> FILE NUMBER : <br /> SERVICES <br /> Water <br /> ❑ <br /> Public Service Provider: Will Serve Letter Provided <br /> Distance to <br /> ❑ Public Water: <br /> Private <br /> Existing Well New Well Well Replacement <br /> � ❑ ❑ <br /> Wastewater Disposal <br /> ❑ <br /> Public Service Provider : Will Serve Letter Provided <br /> Distance to <br /> ❑ Public Sewer : <br /> Existing Septic System New Septic System Septic System Replacement <br /> Private ❑ ❑ ❑ ❑ <br /> Description of process wastewater: Volume of process Method of disposal : <br /> If the project will result in wastewater: <br /> process wastewater provide <br /> the following information : <br /> Storm Drainage <br /> Service Provider : Will Serve Letter Provided Distance to <br /> Public ❑ El Drain : Storm <br /> Drain : <br /> Existing On -site Retention Pond New On -site Retention Pond Natural Drainage <br /> Private ❑ ❑ `� <br /> Other Public Services <br /> School Service Fire Protection Service <br /> Service Provider Distance to Service Provider Distance to <br /> School : Fire Station : <br /> Page 3of6 <br /> 03 /28 / 2023 <br />