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o�4�tN. APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Oq CiFp'RiN�P <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Foota a or Acreage <br /> � D G <br /> L . <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed ❑ <br /> Existin <br /> Private Water❑ Existing Well(a 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 ❑ Existing Septic System ® New SSem ❑ 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 Pond s ❑ Natural Drainage/No Changea Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> .T� <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> e <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> W '• Z�/ Yes❑ No 9 Yes❑ No <br /> Yes❑ No ❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> 2 Yes ❑ No[n Yes❑ No <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> F:TEV5VC\P1anning Application Forms\ Page 4 of 7 <br /> Lot Line Adjostment.doc.(Revised 6-4-041 <br />