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Qul� APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> tq; <br /> k \ :1 <br /> FILE NUMBER: <br /> 4 !FO <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> EAsting <br /> Existin or Proposed Use of Parcel <br /> Footage or Acreage Foota a or Acreage <br /> S1400- 29 1f01rrf 97 5 Pro I . 2 .1 .S] <br /> AG h�,apEsSITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Service Provider Re uired Water Feet <br /> ' Private Water❑ Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> i Disposal <br /> Service Provider Re uired Sewer Facility <br /> Proposed ❑ <br /> Existin <br /> On-site Sewage <br /> Dis sal C3 Existin 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 /> ❑ <br /> Required to: Ponds <br /> Proposed <br /> Existing❑ <br /> w <br /> Private Stone <br /> Drainage❑ On-site Retention Pond s ❑ Natural Drainage/No Chane E' Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> l School Service Fire Protection Service <br /> f Distance to Elem <br /> ! Service Provider School Service Provider Distance to Fire Station <br /> L ON NII BIZ M I <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> �l1LK� �^11Z0✓ 0 Z 2- Yes❑ No Yes❑ NoRl <br /> Yes❑ No❑ Yes❑ No❑ <br /> i <br /> Prod Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ I ❑ Yes❑ No❑ <br /> F:\DEVSVOPlanning Application Forms\ Page 4 of 7 <br /> Lot Llne Adlustment.doc.(Revised 5-4-04) <br /> k <br />