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APPLICATION - VARIANCE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Service Provider Annex-Formation Distance to Public <br /> Public Water Required Water (Feet) <br /> Existing ❑ <br /> Proposed ❑ <br /> Private Water❑ Existing Well ff New Well ❑ Well Replacement ❑ <br /> ageps :;:.>::;..:.;: <br /> ::.::..:.>;:.;;;:.:::..:.;:::•..•:.:...:::::...............::::::.:::•:.•:.:::.. <br /> Public Sewage Service Provider Annex-Formation Distance to Pblic <br /> Disposal Required Sewer Facil' <br /> Existing ❑ <br /> Proposed ❑ <br /> On-site Sewage Existing Septic System EX New Septic System ❑ Other ❑ <br /> Disposal❑ <br /> >; m.©rel.,..,:.:: : >:; `<::::> <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detention <br /> Drainage Required to: Retention Po ids <br /> Existing ❑ <br /> Proposed ❑ <br /> Private Storm <br /> On-she Retention Pond(s) ❑ Natural Drainage/No Change ® Other ❑ <br /> Drainage❑ <br /> :.::. IsctitcTty. _. _ T tephona&ervii a <br /> :...:_. <br /> Service Provider Distance to Service Service Provider Distance to <br /> Service <br /> P. G. & E. Adjacent Pacific Bell Adjacent <br /> 777:777777=7 <br /> ' ao! etvic Ira pratectian service <br /> Service Provider Distance to Elem Service Provider Distance to ire <br /> School Station <br /> Lodi Unified 2 miles Clements Vol. Fire Dist. 2 mil4s <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalk' <br /> Atkins Road 40 foot 18:'- Yes M No❑ Yes❑ No [f <br /> Yes❑ No❑ Yes❑ No❑ <br /> 1 <br /> -3- <br />