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Uty APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Yirs o'R�f, . I <br /> PROPOSED PARCELS <br /> Parcel Number Existin or Pro osed Use of ParcelExisting Square Proposed Square <br /> Foote e or Acrea Foota a or Acres e <br /> 2 A?/ A A<. + <br /> YL 73< Yf . c <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Service Provider Aonex-Formation Distance to Public <br /> Proposed El <br /> Re wired <br /> Existin Water Feet <br /> ❑ <br /> Private Water Existin Weil <br /> New Well ❑ Well Re lacement ❑ <br /> Public Sewage Sewage'Disposal <br /> Disposal Annex-Formation Distance to Public <br /> Proposed ❑ Service Provider <br /> Existin E] Re wired <br /> Sewer Facilltv <br /> On-site Sewage <br /> Dis osal Existin Se tic S stem ❑ <br /> New Se tic S stem Other ❑ <br /> Public Storm <br /> Storm Drainage <br /> - <br /> Drainage Service Provider (if Public) Annex-Formation <br /> Proposed ❑ Terminal Drainage Detention-Retention <br /> Existing C] Re uired to: Ponds <br /> Private Storm <br /> Draina a On-site Retention Pond(s <br /> ❑ Natural Drainage/No Chan a Other ElElectricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider <br /> i� Distance to Service <br /> School Service <br /> Fire Protection Service <br /> Service Provider Distance to Elem - - - - <br /> School Service Provider Distance to Fire Station <br /> Existin Roads <br /> Road/Street Ne a R.O.W. Width Pavement Width Curb/Gutter <br /> r � Sidewalks <br /> F Yes <br /> ❑ No Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> Pro osed Roads_ <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter <br /> Sidewalks <br /> Yes ❑ No ❑ I Yes ❑ No ❑ <br /> Yes ❑ No ❑ IYes ❑ No ❑ <br /> F:IDEMCIPlanningApplicawn Forms\ Page of 7 <br /> Lot Line Adjustment.doc. (Revised 05-11-09) <br />