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p°u'N APPLICATION - DEVIATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- - <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 Water❑ Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed ❑ � <br /> Existin <br /> iy 4­1 <br /> On-site Sewage <br /> Disposal osal ❑ 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 ❑ <br /> Required to: Ponds <br /> Existing ❑ c S y y <br /> Private Storm <br /> Drainage❑ 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 /> PU t L 150 ` pr-T-1 -7- --75 ' <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> :16f:5 -k_- rM 6'°#k0_ 01577. M ItE 5 <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> PAA n,40 v Yes,Z No ❑ Yes ❑ Noz <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F DEVSVC\Planning Application Form s\Deviation.doc.(Revised 1-6-03) Page 3 of 6 <br />