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A � f <br /> LOT LINE ADJUSTMENT <br /> SAM N COWZY COMMUNiTY DMAELOPMENT PEPARTMEN <br /> 'i �7 `�. � p $ �'��• Sd`i �����As S,� "�(`b`.�.��i^� �4��4{-�3 �Y +'(Y Y��sal!1 LT3 4��f�F�� <br /> 1Tr`r F 1A <br /> Parcel Number .Existing or Proposed Use of Parcel Existing Proposed <br /> Square Footage Square Footage <br /> orAcreage orAcreage <br /> 119 -.�'Y Zd'R'F eS� ,jtq,1 "AoS� 3 NilA�i w .ki <br /> "I <br /> 111011 <br /> 1 .- i _ <br /> r��.•. H:x, ,7�}Yep �(�vh.'1+_ .7�1M'!l GT SCS�z i #,T��,,�S�tc��.F,<L.�� <br /> �N-s, <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Existing D Required Water(Feet) <br /> Proposed rB" <br /> Private Water O Existing Well O New Well G--I, Well Replacement ❑ <br /> ty 4`w Erni/ /� 5 W <br /> N4��t�ar�4 ' <br /> Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal Required Sewer Facility <br /> Existing D <br /> Proposed❑ 4 <br /> f <br /> On-site Sewage Existing Septic System ❑ New Septic System 0'-' Other ❑ <br /> Disposal❑ <br /> g� <br /> v � ` <br /> �cY VON <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention- <br /> Drainage Required to: Retention Ponds <br /> Existing O <br /> Proposed O <br /> Private Storm On-�lte Retention Pond(s)❑ Natural DraloagatNo Change Other ❑ <br /> Drainage❑ f <br /> w }aFI$c�trlCJty F4 ti, NBurei;aas SFS rizt ; yah' <br /> oma: 3 rI, <br /> Service Provider Distance to Service Provider Distance to <br /> Service Service <br /> Telephone Service ,} ;,., .. � Ckble,Televlslon Servlcs <br /> Service Provider Distance to Service Provider Distance to <br /> Service Service <br /> PJIi•zrrw <br /> ,,StihoolSsrvlce {si ta # ° {�� { '.i °, FJreProtetrflonServlce , <br /> Service Provider Distance to Elam Service Provider Distance to Fire <br /> School Station <br /> nnRoadd/lSttrest Name R.O.W.1Mdth Pavement Width Curb/Gutter Sidewalks <br /> U✓ l�C/L Yes 0 No Yes O No 0: <br /> Yes L7 No❑ Yes❑ No❑ <br /> ggam�. <br /> #�'re A �. �.� .. <br /> L?r,�?�.Ld ��5 r, x i vxm. i%x.' <br /> Road/StreetName R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No Yes❑ No Br-'Yes L7 No O Yes❑ No❑ <br /> h OcvaGR/IOANxtpLA 1PPa/LOTI,IHCADJAPPPOBM NLY 2'/1/41 ' -3- <br />