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).°P� APPLICATION - DEVIATION <br /> .......... .. <br /> N < 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 /> Existing ❑ <br /> FPrivate Water,)gj 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 /> Existing ❑ <br /> FOn-site Sewage <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 /> ❑ <br /> Required to: Ponds <br /> Proposed <br /> Existing ❑ <br /> Private Storm <br /> Draina e On-site Retention Pond(s) ElNatural Drainage/No Change Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No.L�- Yes ❑ N <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F:\DEVSVC\Planning Application Forms\Deviation.doc.(Revised 5-11-09) Page 3 of 6 <br />