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b APPLICATION- SITE APPROVAL <br /> PRIVATE RIGHT OF WAY — ANTIQUATED SUBDIVISION <br /> Yi ; I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> -. FILE NUMBER: SA- <br /> �..�.z <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existin ❑ <br /> Private WaterQ, Existing Well ❑ New Well &I Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Existing ❑ <br /> On-site Se,1 e <br /> Dis sal Existing Septic System ❑ New 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 /> Dmina a On-site Retention Ponds ❑ Natural Dmina a/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance[o <br /> /Service Provider Servii�ce Service Provider Distance to Service <br /> --Spc <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> oa v 5 row t b CEJ <br /> Existing Roads <br /> Road/StreW Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Cp , 1 Qf �Zt-i1G�YG� Yes❑ NoZ Yes❑ No <br /> Yes❑ No Yes❑ No <br /> FIDEVSVOPtannirg Application Forms\Site Aplxwai) Page 3 of 7 <br /> Private Right of Way.(Revised4-2-03 <br />