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Aj <br /> APPLICATION - DEVIATION <br /> N SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: DV- <br /> �1ppR <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 n,( � J/' S/ <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❑ f I <br /> Existing IZ, i rr� 1 ) '1" U 0 .S <br /> On-site Sewage <br /> Disposalsi [:1Existing 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 /> Required to: Ponds <br /> Proposed F] <br /> Existing❑ A//f <br /> Private Storm <br /> Drains t❑ On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other El <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> 4> 5i f"La- <br /> School Service Fire Protection Service <br /> Service Provider Distance to ElemSchool Service Provider Distance to Fire Station <br /> J fa, l-a /rl L/mss <br /> D <br /> Existing 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 /> F:\DEVSVC\Planning Application Forms\Deviation.doc.(Revised 5-11-09) Page 3 of 6 <br />