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i <br /> + APPLICATION LOT LE ADJUSTMENT <br /> � aq,4t�ltd.• <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :K <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Pro sed UF±of Parcel Footage or Acreage Footage or Acreage I <br /> o ra e Cz5 taee <br /> ds <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 Re lacement ❑ <br /> Sewage Disposal <br /> Pubic Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> r Proposed❑ <br /> Existing <br /> On-site Sewage <br /> Dis sal Existin Se tic S tem New Septic S tem 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 Pond s Natural Drainage/No Chane Other <br /> Ellectriclty ;'Telaphona Service ; <br /> Distance to <br /> Service Provider Service Service Provider Distance to rvice <br /> School Se cel F[r�Protection Service <br /> Distance to E mem <br /> Service Provider School Service Provider ' Distance to Fire Station <br /> O/h , ` r <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> / Yes❑ No K Yes❑ No Nr <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proosed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes El No El Yes El No El <br /> Yes❑ No❑ Yes❑ No❑ <br /> F 1DEMsvCl%nn ft Aokxdlon Formal Page 4 of 7 <br /> Ld Una Ad U0Y*ntdoc.(RwkW 64-04) <br /> E <br />