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A, L <br /> � - APPLICATION - DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> f •.._ r .� , FILE NUMBER: DV <br /> fg'f�r_o3 <br /> SiY IMPI�r)1 MEN CSAN11SF liG S.. <br />[ .. .... <br /> Wafer ....... :. ...... <br /> ... .. .. ... <br /> Public Water Annex-Formation Distance to Public <br /> f Service Provider <br /> Proposed ❑ Re uired Water Feet <br /> -Existing® �� � G fes.. <br /> Private Water❑ Existing Well ❑ New Well ❑ <br /> ';gspo <br /> Well Replacement ❑ <br /> ::.:. <br /> :: .. <br /> Public Sewage # Annex Formation Distance to Public <br /> Disposal i Service Provider Required Sewer Facility <br /> Proposed❑ I <br /> Existing <br /> On-site Sewage <br /> Dis osal[-IExisting Septic System ❑ New Septic System E] Other El <br /> 5tofm <br /> Drs mage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminaf Drainage Detention-Retention <br /> Proposed ❑ Required to: Ponds <br /> Existing <br /> Private Storm <br /> Drainage❑ n-site Retention Pond(s) ❑ Natural Drainage/No Change ® Other ❑ <br /> Elec4 ip�ty. Telslea <br /> . .pone <br /> .. + <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> 62 <br /> R <br /> Sohoof5ervrce <br /> Flee Prafect�cn Satvtce <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fre Station <br /> IE=xls� itifi R+aads << <br /> : . <br /> :... ... <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ® No❑ Yes® No❑ <br /> ! Yes❑ No❑ Yes❑ No❑ <br /> i <br /> FA)EVSVOPlanning Application FonnslDeviation.doQ(ftevlsed 8.03-04) Page 3 of 6 <br /> a <br />