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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 10 <br /> 8 Y k r 4 ai.tao.c r y4¢r = t <br /> Cipm <br /> Parcel Number Existing or Proposed Use d Parcel Existing Proposed <br /> Square Footage Square Footage <br /> a Acreage or Acreage <br /> / el/ r= 67.17C 17 s />ce <br /> rc s rL .26( <br /> Eel S Y 2¢a Y>L f aYTf 5#f'j' gvA <br /> n , - , <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Existing❑ Required Water(Feet) <br /> Proposed❑ <br /> Private Water Existing Well New <br /> YWall <br /> ..0 Well Replacement ❑ <br /> 14,Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal Required Sewer Facility <br /> Existing❑ <br /> Proposed❑ <br /> On-site Sewa a Existing Septic System ,ry New Septic System ❑ Other ❑ <br /> Disposal <br /> " Sterm Drall'ldgtl 0111 Ck Ya <br /> Public Storm Service Provider Annox-Formation Terminal Drainage Detention- <br /> Drainage Required to: Retention Ponds <br /> Existing ❑ <br /> Proposed❑ <br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑ <br /> Drainage❑ <br /> erectrloky rtturat ass <br /> Service Provider Distance to Service Service Provider Distance to <br /> Service <br /> OO h,upoa Sbtvltx <br /> Service Provider Distance to Service Service Provider Distance to <br /> pQ Service <br /> hWSS <br /> Service Provider Distance to Elam Service Provider Distance to Fire <br /> School I I Station <br /> 3 x . <br /> x rnf ;v,Sz b %l�iH7lg Rs> <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Clutter Sidewalks <br /> -?r Yee❑ FJo Yea❑ No <br /> Yes❑ No❑ Yee❑ No❑ <br /> k f :•s' asz�y�s$"5 a... 3` �,.,:.'•` r��' ::a`rF•r. )a a <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yee❑ No❑ Yes❑ No❑ <br /> Yea❑ No❑ Yee❑ No❑ <br /> -3- <br />