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APPLICATION— SITE APPROVAL <br /> PRIVATE RIGHT OF WAY- ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Public Water Service Provider Annex-Formation Distance to Public Water <br /> Proposed❑ Fee <br /> Required (Feet) <br /> Existing❑ <br /> Private Waters Existing Well ❑ New Well 0 Well Replacement ❑ <br /> ��rt-r Y�:•l��is!'W`i.�%�v" ,�1,';��N��!�1.�.�r��i':wFr •�ti�`i�,fpr��.5@W8�9,h�ISpO3AI �'����� ��'PT; � '�� t ��k�+, ,.,. j>.'- ' <br /> Public Sewage Service Provider Annex-Formation Distance to Public sewer <br /> Disposal Required Facility <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewage Existing Septic System ❑ New Septic System ® Other ❑ <br /> Disposal 0 <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Required to: Ponds <br /> Proposed❑ <br /> Existing❑ <br /> Private Storm On-site Retention Pond(s) 0 Natural Drainage/No Change ❑ Other ❑ <br /> Drainage <br /> ��E1ectr1ciW r <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> Q t � ars_ S' 4Gy <br /> GeV <br /> Service Provider Distance to Elem Service Provider Distance to Fire <br /> B II School 1^ I Station <br /> L�vAll �ry S l hi s i � -rr r5 dire �� S YYti'►�'�� <br /> ',kr r� time'+'�5i"cif rl�,'•;F � F h ai �.�a.�:. ��. <br /> FIs n ad . <br /> Tr <br /> Road/Street Name R.O..W. Width Pavement Width Curb✓Gutter Sidewalks <br /> ii a , SV Yes❑ No 0 Yes❑ No D <br /> 96 8 Yes❑ No 0 Yes❑ No <br /> -3- <br />