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;. '. ,APPLICATION - LOT U E ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existina or Pr000sed Use of Parcel Footage or Acreage Footage or Acreage <br /> ye-5- ---' .Z A— <br /> !le, <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Waterer Provider Annex-Formation Distance to Public <br /> Proposed C] R uired Water Feel <br /> Existing <br /> Private Water Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Existin <br /> On-site <br /> Ms osal Existing Septic System New Se tic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Dralnage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention i <br /> Proposed❑ Required to: Ponds <br /> Existing❑ <br /> Private St <br /> Drainage On-site Retention Ponds Natural Draina eJNo Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provides School Service Provider Distance to Fire Station <br /> _ O r <br /> ExlstJn Roads <br /> Roadl et Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 4�92 Yes❑ No Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ k <br /> ProDozed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> t Yes❑'tNG❑ Yes❑ No❑ <br /> F:IDENSVC%Piam"Application Formsl Page 4 of 7 <br /> W tine Adjusunemdoc.tRevlsW&4-04) <br /> _. fi <br />