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PLICATION — LOT Yo, JE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �; ,,, PR01?OSED PARCELS, <br /> jExisting Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Foota a or Acreage Footage or Acreage <br /> r® vs e- <br /> tqD.S <br /> SITE IMPROVEMENTS AND SERVICES <br /> Watlsr <br /> Annez-Formation Distance to Public <br /> Public Water Service Provider <br /> Proposed ❑ Required Water Feet <br /> , <br /> Existin ❑ <br /> LPrivate 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 /> Existing ❑ <br /> On-site Se% Ne <br /> Disposal Existing Septic System New Septic System A 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 Ponds ❑ Natural Drains a/No Chane W. 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 Provider School Service Provider Distance to Fire Station 1 <br /> Existing Roads <br /> Road//Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> iwd' oc?A R (� Z r Yes❑ No g Yes❑ No 56 <br /> Yes❑ No ❑ Yes❑ No ❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width CurblGutter Sidewalks <br /> Yes ❑ No❑ Yes ❑ No ❑ i <br /> Yes❑ No ❑ Yes ❑ No ❑ <br /> FADEVSVC1Planning Application Formsl Page 4 of 7 <br /> Lai Line Adjustment.doc.(Revised 63-03) <br />