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APPLICATION- MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PROPOSED PARCELS <br /> Parcel Number Existing or Proposed Use of Parcel _ Square Footage <br /> or Acreage <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Service Provider Annex-Formation -Distance to Public Water(Feet) <br /> Existing o Required <br /> Proposed o <br /> Private Water_X Existing Well X' New Well o Well Replacement o <br /> Sewage Disposal <br /> Public Sewage Service Provider Annex-Formation Distance to Public Sewer <br /> Disposal Required Facility <br /> Existing o <br /> Proposed o <br /> On site Sewa a Existing Septic System New Septic System o Other o <br /> Disposal <br /> Storm Drainage <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-Retention Ponds <br /> Drainage Required to: <br /> Existing o <br /> Proposed o <br /> Private Stor On-site Retention Pond(s) o Natural Drainage/No Change Other o <br /> Drainag <br /> Electricity Natural Gas <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> Telephone Service Cable Television Service <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Service Provider Distance to Elem Service Provider Distance to Fire Station <br /> School <br /> �4- <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes o No k Yes o No�( <br /> Yes o No o Yes o No 0 <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes o No o Yes o No o <br /> Yes o No o Yes o No o <br /> -3- <br />