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L Y APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ?• FILE NUMBER: <br /> PROPOSE©PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Foo a or Acrea a Footage or Acrea e <br /> SITE IMPROVEME14TS ANI)SERVICES <br /> water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Requir <br /> edter Feet <br /> Proposed❑ <br /> Existi <br /> Private Water ExistingWell Now Well ❑ Replacement ❑ <br /> Sewage,Disposal <br /> Public Sewage <br /> Ann Formationce to Public <br /> Disposal Service Provider Requireder Facili <br /> ty <br /> Proposed❑ <br /> Existi <br /> On-site Se e <br /> Dis sal Existin Se tic System New Se tic S ❑ .Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Dron-Retention <br /> Proposed ed <br /> Po ❑ <br /> Required <br /> to- Ponds <br /> Existing❑ <br /> f Private Storm <br /> Drainage 0 1 On-site Retention Ponds Natural Drainage/No Change Other (] <br /> Electricity. <br /> Telephone Servic e <br /> Distance to <br /> Service Provider Service Service Provider <br /> Distance n <br /> to ce to Service <br /> Z=- -.--S-1 - s! <br /> ,09 <br /> School Service Fire Pratsetion Service <br /> Distance to Elem <br /> Service Provider S hoof Service Provider Distance to Fire Station <br /> a � IG O✓' � !C d/' <br /> ExI5Uh :Roetls <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> -� Yes❑ No, Yes❑ No to. <br /> Yes❑ No❑ Yes❑ No❑ <br /> roads <br /> Road/Street Name R.O.W.Width - Pavement Width Curb/Gutter <br /> Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> FADEvsvClPlanning AppficaL'on Formsl Page 4 of 7 <br /> Lot Line AdjustmentAm.(Revised"-04) <br />