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APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> a�!F Oaf <br /> i PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acrea a Foots a or Acreage <br /> w (A aFLr (T" S <br /> i <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water f <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Reguired Water Feet <br /> Proposed❑ <br /> Existing <br /> i <br /> Private Water❑ Existing Well New Well ❑ Well Replacement ❑ <br /> is Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sewage <br /> Disposal❑ 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 /> Drains e❑ 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 /> School Service Fire Protection Service <br /> Distance to Elam <br /> Service Provider School Service Provider Distance to Fire Station <br /> 2 <br /> .I <br /> Existing Roads <br /> Road/Street Name R.Q.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 47"F:: yc, 61mvez Yes❑ No Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> �i <br /> C Yes❑ No❑ Yes❑ No❑ <br /> [� Yes❑ No❑ Yes❑ No❑ <br /> POEVSMPlanning Application Formsl Page 4 of 7 <br /> La[Line Adjustment.doc.(Revised 6-4-04) <br />