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PLICATION -- QT E ADJUSTMENT' <br /> SAN JOAQUlN COUNTY COMMUNITY DEVELOPMENT '"rEPARTMENT <br /> FILE NUMBERS. . <br /> MRS. <br /> yte5:,- ' <br /> ry l '� " <br /> R.111% <br /> "` OSS <br /> r.._ ,.x� _ "°`Extst�r►g��quaF�;� :Pto�. p <br /> Foots a or Acres a Foots a er,Acres e <br /> Parcel Number Existin or Proosed.Use of.Parcel <br /> f. <br /> nes � ,>�.�;�',.'�, �. �3fRuz 11■.` w�kF.F�'p'�!""INr I"'�, <br /> 1dF3t5}�' 'TTS�}�i{�StrR '� f �� �n �Oxl*' � �� q+7GR :.lyd1 .,., <br /> Y .f 7 ,it claw <br /> ns•t+ca . t _. t : J y s c v'- A,^��tC L. :, } } � <br /> `r ""' Y Annex Formation Distance to Pubhc1 <br /> Water Feet <br /> Public W.ater' <br /> Service Provider Re,Lilted <br /> Propbsed El <br /> Existin rf�f <br /> New.UVeII.❑"' n <br /> W 11 e 1 <br /> Existin Net <br /> e R sterna t ❑ <br /> Private Water <br /> '-iri i ter ,?✓ a� r Sa l '4t-' - ni, '"` -.. t .,. - .. -, I <br /> �^ Sewage Dispq'sal' <br /> Annex_Formation Distance to Public <br /> Public Sewage Re uired Sewer Facili <br /> Disposal,. Service Provider <br /> Proposed <br /> Existin {: <br /> On-site Sewage New Septic S stem ❑ Other ❑ <br /> 0 i osal❑ Existing Se tic System <br /> . , Storni Drairtage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider.(if Public) Re aired to: Ponds <br /> Proposed❑ <br /> Existing❑ <br /> Private StormNtural Drains elNo Ghan e ❑ Other El <br /> Draina a On-site Retention Pand s Ela <br /> Telephone Service <br /> bectficity <br /> Distance to Distance to Service <br /> Service Provider Service Service Provider <br /> School Service Fire Protection Service <br /> Distance to Elem Service Provider Distance to Fire Station <br /> Service Provider School <br /> Existin Roads <br /> RoadlStreet Name R.O.W.Width Pavement Width CurblGubter Sidewalks <br /> z Yes❑ No Yes❑ No <br /> O Yes❑ No Yes❑ No <br /> Pro osed Roads <br /> RoadlStreet Name R.O.W.Width Pavement Width Curb/Gutter. Sidewalks <br /> Yes❑ Na❑ Yes❑ No❑ <br /> Yes❑ No ❑ Yes❑ No❑ <br /> FADEvsvcu?ianning Appkation Forms\ Page 4 of 7 <br /> Lot fine Adjustment.doc.(Revised 6-3-03) <br />