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<br /> LOT LINE ADJUSTMENT
<br /> M DEV MENr DEPARTMEN
<br /> �-
<br /> �
<br /> Parcel Number F�cisting or Proposed Use of Parcel Existing Proposed
<br /> Square Footage Square Footage
<br /> or Acreage or Acreage
<br /> A'S Y7
<br /> -V s+i°3 { li,S cd"°� P{i�0,,s
<br /> r
<br /> � '
<br /> Publlc'Wate Service Provider Annex-Formation Distance to Public
<br /> Existing Required Water(Feet)
<br /> Proposed O
<br /> Private Water❑ Existing Well 0 New Well ❑ Well Replacement ❑
<br /> y"##: 7 r„tFl J"4 4�Itf�1,! 3
<br /> 3 b1. H,�1��°`,s `€�!T r� ,€ ili�t"� {.f:�dtrl$mk.t I'_` ej Ito t:€
<br /> posal€+'ie �+ �kJ�+dalIh!t� �1���� �t4 ' �� i :14, ro
<br /> Public Sewage Service Provider Annex-Formation Distance to Public
<br /> Disposal Required Sewer Facility
<br /> Existing
<br /> Propose ❑
<br /> On-site Sewage Existing Septic System ©,: New Septic System © Other
<br /> Disposal O
<br /> � 1yd�
<br /> \ �} fT A l }p( ¢t }
<br /> p$ t{�rmiDralna.Qe �'•" ",i:'�,.,�a`k,�Ln°'_. n `r!I. f€{a�. +r�'ii!�(h,
<br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-
<br /> Drainage Required to, Retention Ponds
<br /> Existing❑
<br /> Proposed❑
<br /> Private Storm On-site Retention Pond(s).❑ Natural Drainage/No Change © Other ❑
<br /> Drainage O
<br /> o--,g
<br /> MY,
<br /> n
<br /> Or
<br /> „ I@Ct17Clts! xn n ��I t Nyatura {$S
<br /> IAN
<br /> .. -_.. W- i={
<br /> Service Provider Distance to Service Provider Distance to
<br /> Service Service
<br /> AIN'
<br /> } � si ` a7elepilorieService .' .., � � b'Telev sfonServlce _� :
<br /> Service Provider Distance to Service Provider Distance to
<br /> Service Service
<br /> {�6 .§'�,�p,t k~•.. �t s..- s s:_r 3�"3�. mr,, _"4k $^€{ -,E,:�`, ,,� !�,,.. :}a :�. ,k
<br /> € S §
<br /> 4School:Service r
<br /> �... _€, slFiYe Protection Service ��.°
<br /> ervlce P v�(d Distance to Elem Service Provider Distance to Fire
<br /> Un �, School Station
<br /> /6 MIC51 40,-Asi , es
<br /> x hiY li t`.,p � �y '��'s 3•^E f l� Y�J - i; 11 �1
<br /> �-
<br /> °!r ,P�€Y,, �i,���. g-. «V rt• ,1f° .�$2,<LK�dr�.r.tb.,!,.r..t�F`7��€P9� I{�,!-„7:-It, titir�,N;dS;, t...f,}�,
<br /> Road/Streef Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks
<br /> F Yef 47 No Yea lel N4
<br /> � !?0.46� RO �31s
<br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks
<br /> Yes O No❑ Yes U No
<br /> Yes❑ No❑ Yes O No
<br /> rl OevscjkitmRK/pi.mA>rr/wTL.imrAUJA9rronm Rev 911/99 —3-
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