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o�4gl^r. <br /> c° APPLICATION — DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ...... FILE NUMBER: DV- <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> 7rPublicr Service Provider Annex-Formation Distance to Public <br /> "� Required Water Feet <br /> Existin ( �I17CD�Y1 VI ��Cf UYlI CI �Ct� rIC /IUII� 01 51 ; <br /> Private Water❑ ExistingWell ❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> ffst <br /> Annex-Formation Distance to Public <br /> Service Provider Required Sewer Facility <br /> , / <br /> L1 ►7C0�/1 V r <br /> On-site Sewage <br /> Disposal❑ Existing Septic System 2/ 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 /> PPrivate Storm <br /> )rainage❑ On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> CiCr C �T.a t--bed► L C-/1 -�,, <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fire Station <br /> {- <br /> Inccls� � ni �tEc i,-35ft �>il�tC0 <br /> - Lt — - - -- - - - -- Rha ]Yes <br /> - — -- <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutterewalks <br /> dYe�Uf� Yes [ No❑ ❑ No❑ <br /> OOck Cf Yes No❑ � No❑ <br /> F:\DEVSVC\Planning Application Forms\Deviation.doc.(Revised 6-03-04) Page 3 of 6 <br />