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a, ,7 APPLICATION — LOT Lhvt ADJUSTMENT <br /> a. ..o <br /> r.' y 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 /> P Cel I i La twee -� 17 6c- '0 <br /> 12 14 al >1.,$3 AcAP Fac <br /> G r 55 f'o bird@'�2RMinGfs'. O. S. <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❑ Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facili <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sewage <br /> DisposaLu—im I we Existing Se tic S tem ❑ 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 Prov der Service Serv'ce Provider Distance to Service <br /> nc .SL r �- k 5 ; FC. <br /> School Service _ - Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> L CCL gmir/ `li <br /> kodstin . Roads <br /> Road/Street Name R.O.W.Width .,-Pavement Width Curb/Gutter Sidewalks <br /> Gr IPS.V C 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 /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> -FZEMCIPlanning Application Formsl Page 4 of 7 <br /> Lot Line Adjusanentdoc.(Revised 0511-09) <br />