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t <br /> ip <br /> APPLICATIOf J � SITE APPROVAL <br /> PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE HUMBER: SA- <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 /> 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 /> Existing ❑ <br /> On-site Sewage <br /> Disposal [a' Existing Septic System ❑ New Septic System [ti} Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Re uired to: Ponds <br /> Existing <br /> Private Storm <br /> Draina e ❑ On-site Retention Ponds ❑ Natuial Draina a/No Chan a [� 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\'Vidth Curb/Gutter Sidewalks <br /> I/v L 4- In-JE � Yes El No L/ Yes ❑ No <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> F:IDEVSVCtPlanning Application Fonns\.Site Approval) Page 3 of 7 <br /> Private Right of Way.(Revlsed4l-2-03 <br />