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AQ�rM 'PLICATION - LOT LIE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> C1i;6R . <br /> "1PROP�JSED PARE1_S z <br /> Eki8ting Square ' ­13 roposed Square <br /> Parcel.Number Existiri or Proppsed Use of Parcel Foota a or Acrea e..- .Footage or Aarea e <br /> r � y • <br /> IJ <br /> ` 7:r a �` "v Y 45 ;SITE'--1MPROI/EMt�TSJNi]SERVICES, g , R y9 r > , <br /> ., Vlfater <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing❑ C'j <br /> F-Private-Water'El Existing Well : New Well'_q Well Re lacemefht El <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 N _ <br /> Disposal❑ <br /> 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 Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> � a S _j ` 2 <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> oad/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No IX Yes❑ No 0 <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> i <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No ❑ Yes❑ No❑ <br /> Yes ❑ No ❑ Yes❑ No❑ <br /> F:\DEVSVCTlanning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 63-03) <br />