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rnV.l.y. APPLICATION - LOT Lit -'. ADJUSTMENT <br /> r:• 'y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number ExisUn w Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> 1 �qmi t 3 A,c Ac <br /> y AC . qG. <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Ann tion Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed❑ <br /> Existino❑ <br /> Private Watero Existing Well 19 New Well Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re uired Sewer Facility <br /> Proposed ❑ <br /> Existin ❑ <br /> On-see Se, e <br /> Die asst Existing Septic System New Septic System Other ❑ <br /> Stone 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 /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> 1�. z C n- StF S o <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> l t rF z tY.t t o Li t= It r0 e <br /> Existing Roads <br /> Road/SVeet Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> V - 1 32` Yes❑ No 0 Yes❑ No 0 <br /> Y.e epi �_ 40' 241 Yes❑ No Yes ❑ No <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes ❑ No ❑ <br /> Yes❑"No❑ Yes ❑ No❑ <br /> FsoEvsvcwlarwry App6aauaa Formst Page 4 of 7 <br /> LN line Adjus=n Ldm.(Revised 6.4-04) <br />