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AN LUT LINE ADJUSTMENT AN 1N TY QOMM2NIrY DEVEL PMENT DEPARTMENT = is R4P0,5ED AARGtcLS Parcel Number Existing or Proposed Use of Parcel Existing Proposed Square Footage Square Footage or Acreage or Acreage SX, h vim , 3 S �,; r m,J':a �i. .� � ;$!. M;��/�+M�N7��f,CIVD'S�RVIGES .•c:` -�,`Y1'ato,A'�„�� Public Water Service Provider Annex-Formation Distance to Public Existing ❑ Required Water(Feet) Proposed Private Water Existing Well New Well Well Replacement ❑ Public Sewage Service Provider Annex•Formatlon Distance to Public Disposal Required S e wer Fa cill ty Existing O Proposed❑ On-site Sew Existing Septic SystemXNew Septic System ❑ Other ❑ Disposal `SC017ttDralhage Public Storm Service Provider Annex-Formation Terminal Drainage Detention- Drainage Required to. Retention Ponds Existing❑ Proposed❑ Private Storm On-site Retention Pond(s)'❑ Natural Dralnage/No Change Other ❑ Drainage❑ 1=1rfGlty1 .. � s�' 1 <ws•J. NaturelGas Service Provider Distance to Service Provider Distance to Service Service MAP :r3 Te18Phono Servlca Cable Television Service Service Provider Distance to Service Provider Distance to Service Service ac - Inc "Fire Protection 5ervlce'' Service Provider Distance to Elem Service Provider Distance to Fire School Station �1- tai�s� �h 3r "t�,�. p4 ±�.�:-tS r~k � •� .. - ,�, � r rf�t,'�� ; �” _� _,,� xfs ng•14oads ,_.. ' ._ Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks Yes O No Yes !J No l - - — Yes O No 0 Yes'L7 Vo ❑ -- 3'tt yrr� S3ri� r, P OS d,O1 Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks i Yes❑ No❑ Yes ❑ No ❑ Yes❑ No❑ Yes ❑ No ❑ ri 0Yv5 cR/1DARK/PLMAPPs1WTL1 NtADJAPPMM PCV$11199 -3- � I