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44lIlY. A `'PLICATION - LOT UWE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Q <br /> N' X <br /> FILE NUMBER: <br /> 0 <br /> Et ✓ 1. � ls`t F:°.Y�'�s 1,..^Ni.h Yti 5.,,`;d...�,:_-rr` :43 .�ik, -. - <br /> fiJ� <br /> Existing Sguare. Proposed,Sguare <br /> Parcel Number Existin or Proposed Use of Parce( Faota a or Acres a Foots a or Acres e <br /> e'S, A) er. <br /> cd <br /> $}TE IMPROVE}ii� iTR �Ap•SERVIEa$ <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required I Water Feet <br /> Proposed ❑ <br /> Existin C./ <br /> "L C/!l,�4: <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 Faciii <br /> Proposed ❑ �- Q <br /> Existin <br /> On-si-site SeEl <br /> oSElExisting Septic System El New Septic System ❑ Other EJ <br /> Storni Dralnage <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 a On-site Retention Ponds ❑ Natural Drains e1No 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 Elern <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 1 ew"?_ U Yes❑ No V 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 /> RNOEVSVCTIanning Application Formsl Page 4 of 7 <br /> Lot Line Adiustment.doc-(Revised 8-3-03) <br />