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APPLICATION- MINOR SUBDIVISION SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT Parcel Number Existing or Proposed Use of Parcel Square Footage or Acreage .,........ r::.r..::,..c:•..>'•• ... .-... ,,.-> .:ave. .: ,... .'S ,n,...•,.:^,.:.,::{n. ,..;. »t Public Water Service Provider Annex-Formation Distance to Public Existing❑ Required Water (Feet) Proposed❑ Private Water Existing Well New Well Well Replacement ❑ .... Public Sewage Service Provider Annex-Formation Distance to Public Disposal Required Sewer Facility Existing 0 Proposed❑ On-site Sea E�osting Septic WIt" New Septic System Other ❑ Disposal;? /r :..:. 04111441 stirw�'sN Public Storm Service Provider Annex-Formation Terminal Drainage Detention Drainage Required to: Retention Ponds Existing O Proposed❑ Private Storm On+Ne Retention Pond(a))( Ndwal Drallnop Wo Change ❑ Other ❑ Drainage❑ WP Service Provider Distance to Service Service Provider Distance to Service y-00 . Service Provider Service er Distance to Service Provider Distance to Service C' A - f.3 / rlSi e Service Provk1w Diwrtoe to Elam Servioe Provider Distance to Fire School Station R NKIVStr+et NameO.W.Wkah Parvernarrt Width Curb,/Gutter Sidewalks Yes O No Yes O No Yes 0 No 0 Yee 0 No❑ \�•:.;aox. xxr.: ;y<.;, ... Road/Street Name R.O.W.Width Pavement Width Curb/Qutter Sidewalks Yes O No❑ Yes❑ No❑ Yes0 No Yes0 No -3-