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0 U ly <br /> APPLICATION - DEVIATION <br /> '^ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> Sift IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Annex-Formation Distance!to PublicService Provider Re uired Watereet <br /> ExiPros <br /> ting d❑ Hou rU -D<j KAST�_, Pu"t <br /> Private Water❑ Existin 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 /> Existing ❑ HcmSe �ASJ-rz_ i'L_(� <br /> n-site Sewage <br /> O <br /> Dis 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❑ Required to: Ponds <br /> Existing ❑ "otAK T�t� <br /> Private Storm <br /> Drainage e❑ 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 /> School Service <br /> Fire Protection Service <br /> Service Provider Distance to Elem <br /> School Service Provider Distance to Fire Station <br /> FExisting Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> \DEVSMPlanning Application Forms\Deviation_doc.(Revised 1-6-03) Page 3 of 6 <br />