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OP4U'N /•91 1 LICA N ® DEVIATION <br /> �` •� f' ti SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �•... `p.. 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 1.,'_-• --- <br /> Private Water❑ Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to ublic <br /> Disposal Service Provider Required Sewer Fa flit <br /> Proposed❑ <br /> Existin ❑. <br /> On-site Sewage <br /> Disposal® Existing Septic System © New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-R- ention <br /> Proposed ❑ Re uired to: Pond <br /> Existing❑ <br /> Private Storm <br /> Drainage❑C On-site Retention Pond(s) ❑ Natural Drainage/No Change ]f Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> p� 7T'le -r <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem School Service Provider Distance to Fire Stati n <br /> I <br /> BNJ }fJ•@ �4' }Yt f..1GCYY'7�(�v1 .(,14 .i �I4(' f..' ;;t <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidew Iks <br /> r <br /> 10, <br /> I;-)- C-1, (<t'\ Yes❑ No P' Yes ❑ o, <' <br /> Yes❑ No❑ Yes❑ o❑ <br /> RMEVSMPlanning Application FormsTevlatlon.doc.(Revised 5-11-09) Page 3 of 6 <br />