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C) <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> ta:, '' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> x <br /> FILE NUMBER: <br /> �l P; <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel <br /> Footage or Acreage Footage or Acreage <br /> ArL_ <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water ._ Service Provider <br /> Proposed Required Water Feet <br /> ❑ <br /> Existin ❑ <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 Facit <br /> Proposed ❑ <br /> Existing ❑ <br /> On-site Sewage <br /> Disposal ❑ 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 /> Proposed ❑ Required to: Ponds <br /> Existing ❑ <br /> Private Storm <br /> Drainage❑ On-site Retention Ponds ❑ Natural Draina e/No Change Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> -W-7-6 51 TE_ tY+L <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 /> A-ZGojQr f UI Yes❑ No Lg- Yes'O No� <br /> i 51Z t Yes❑ No [N_ Yes ❑ No <br /> Proposed 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 /> FMEVSMPlanning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />