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APPLICATIONLOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> t'ii=p�N� <br /> ,. �,.>. .f;.!�. � ,'r >..�-�� ,..✓.:..,F P�O ���._ 1 �._, :.� ....'.�.��`'1 CES..._ 5"ti 6,6 Yh �I\� r;5-N4 �,�.� 7 k g' -i-. 5 ..:-FIT.� <br /> Existing Square Proposed Square <br /> Parcel Number Existin2 or Proposed Use of Parcel Foota a or Acrea a Foota i a oor/Alcrea e <br /> 14 <br /> Me, <br /> Public WaterAnnex-Formation Distance to Public] , <br /> Service Provider <br /> Proposed ElAiAired Water Feet <br /> Existing ❑ <br /> Pnvate Water <br /> Existing Well New Well <br /> Well Replacement <br /> ` t@Wa <br /> Annex-Formation Distance to Public <br /> Public Sewage <br /> Disposal Service Provider Required <br /> Proposed Sewer Facility <br /> n0i <br /> On-site Ss a e <br /> Dis osal ExistjnQ Se tic S stem New Septic System <br /> ❑ Other ❑ <br /> r s fi <br /> '� K � <br /> r S`brm Drina e # � t LYt <br /> 45 F ,J - r. <br /> Public Storm `" ' L� <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Deter.tion-Retention <br /> Proposed ❑ Required to: Ponds <br /> Existing ❑ <br /> Private StorrD <br /> Drainage On-site Retention Ponds Natural Dralna a/No Chane Other ❑ <br /> r� rr.- r <br /> E� ^aTetephdn2 <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> � z <br /> tc-t ,a` _ i, w-, xis <br /> tizln ARoa, <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks ' <br /> G' Yes ❑ No Yes❑ No, <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> L` oadlStree <br /> t Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No❑ Yes ❑ No ❑ <br /> Yes ❑ No❑ Yes ❑ No❑ <br /> FAIDEVSVOPlanning Application Formsl Page 4 of 7 t <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />