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p4�IH:. ,APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER' <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> Ali- A/5'" Z S 130 4 / <br /> pc. <br /> 3 X/31- / <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> Private Water Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re wired Sewer Facili <br /> Proposed ❑ <br /> Existin ❑ <br /> On-site Sewage <br /> Dis osal B- Existing Septic System ®' New Septic System ❑ 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 jg— 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 /> GiN•S/TC TT S6L DN -S /-9 <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Un <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> ,,Aw ZO V.SIAC Yes❑ No ❑ Yes❑ No❑ <br /> 9,v 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 /> F 0EVSVCTIanning Apphi bon Forms\ Page 4 of 7 <br /> Lot Line Adjuslmentooc.(Revised 6+04) <br />