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� oPqutry <br /> Q: <br /> APPLICATION - DEVIATION <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `gciFORN`p FILE NUMBER: DV- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Proposed❑ Re uired Water Feet <br /> Existin ❑ <br /> Private Water❑— Efnn fn Well rj <br /> Well Replacement U � <br /> Public Sewage <br /> Sewage Disposal <br /> Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sewage <br /> Disposal x❑ Existing Septic System New copr•c System n <br /> Other LJ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage I Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drainage ❑x On-site Retention )Pond(sIxi Natural n <br /> - nycri•oOhianye U Other IJ <br /> Electricity Telephone Service <br /> Distance to <br /> Seryice Provider <br /> Service Service Provider Distance to Service <br /> PG&E 150 ft AT&T <br /> 150 ft <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fire Station <br /> Es ion Unified 1,100 ft Escalon Fire Department 2,400 ft <br /> Existin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> State Route 120 76 ft 40 ft Yes ❑ No❑x Yes ❑ No❑x <br /> Yes❑ No❑ Yes ❑ No ❑ <br /> F:\DEVSVC\Planning Application Forms\Deviation.doc.(Revised 5-11-09) Page 3 of 6 <br />