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` J . <br /> APPLICATION -• LOT LINE ADJUSTMENT <br /> ,., SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> , = FILE NUMBER_ <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> 1 RICE 30.23 AC 12.00 <br /> 2 RICE 72.63 60.00 <br /> 3 RICE 0.11 30.95 <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ ) <br /> Existing❑ <br /> Private Water lACJ Existing Well New Well ❑ Well P.e lacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Proposed <br /> ❑ <br /> On-site Sewage <br /> Disposal <br /> XI Existing Septic System LXJ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-FormationTerminal Drainage Detention-Retention <br /> Proposed F-1Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drainage On-site Retention Pond s ❑ Natural Drainage/No Chane ® Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> PGE AT SITE ATT AT SITE <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Escalon 3 miles Escalon 3.25 miles <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> HENRY ROAD 40 22 Yes❑ No® Yes❑ No[X <br /> ROAD(NOT IN USE) ' 40 0 Yes❑ No 1X Yes❑ No(X� <br /> Proposed Roads <br /> Road/Street Name P..O.W.Width Pavement Width Curb/Gutter I Sidewalks <br /> None Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> F:0rzVSVC1Plannin9 Application Forms\ Page 4 of 7 <br /> Lot Line Adjuslment.doc.(Revised 05-11-09) <br />