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p4U'N APPLICATICM - DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Y'. FILE NUMBER: DV- <br /> i'F ...a <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation F Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existin ❑ <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 Facilit <br /> Proposed ❑ <br /> Existin ❑ <br /> On-site Sewage <br /> Disposal ® Existing Septic System ❑ New Septic System E] 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 Storm <br /> Drain e ❑ On-site Retention Pond(s) ❑ Natural Drainage/No Change M Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> P.G.&E. Adjacent Pacific Bell lAdjacent <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem Service Provider Distance to Fire Station <br /> School <br /> Linden Unified Sch. Dis . 9 Miles Clements Rural 10 Miles <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Capital Road 40' 25' Yes❑ No M Yes❑ No M <br /> Yes ❑ No❑ Yes❑ No ❑ <br /> F:0EVSVCWIanninq Application FOMSMeviatbn.doc.(Revised 603-04) Page 3 of 6 <br />