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tr�PPLICATION — LOT LIE ADJUSTMEkt ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMEN'T' A- FILE NUMBER: PROPQsEa E Existing Square Proposed Square Parcel Number Existing or Proposed Use of Parcel Footaqe or Acreage Footage or Acreage -0-5 1- 1W -20 A-ci Ac. 4---?- Ac, 1051- 04 1 S-Q Ac- 54 A,-e, - 169- Z5- A-c- Annex-Formation Distance to Public Public Water Service Provider Required Water(Feet) Proposed El Existing El Private Water Existing Well New Well El Well Replacement ❑ Sewage Disposal Public Sewage Annex-Formation Distance to Public Disposal Service Provider Required Sewer Facility Proposed El Existing El On-site Sewage Disposal[5r Existing Septic System New Se tic System El Other El Storm Drainage Public Storm Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detontion-Retention Proposed El Required to: Ponds Existing El Private Storm Drainage si- On-site Retention Pond(s) ER Natural Drainage/No Change El Other El Electricity Telephone Service Distance to Service Provider Service Service Provider Distance to Service School Service Fire Protection Service Distance to Elem Service Provider School Service Provider Distance to Fire Station uplq� nt4 IE;ilf ST, Existing Road Road/Street Name R.O.W-Width Pavement Width Curb/Gutter Sidewalks Yes C1 No[9 Yes 0 No EJ Yes 0 No E* Yes [-] No a Proposed Roads Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks Yes El No El Yes El No El Yes[I No El Yes[I No ❑ F:0EVSVC\F`lanning Application Forms\ Page 4 of 7 Lot Line Adjustment.doc.(Revised 6-3-03)