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i <br /> APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Cr'•. �P <br /> AZ�FOR� <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> i <br /> ry o o <br />[ SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing❑ <br /> Private Water❑ Existin 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 /> Existin ❑ <br /> On-site Sewage <br /> Disposal ❑ ExistingSe tic System <br /> New Septic System Other El <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 /> Drains a On-site Retention Ponds ❑ Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service . <br /> Distance to <br /> Service Provider Service Service Provider Distance to S rice <br /> e• <br />' School Service' Fire Protection Service <br /> Service Provider School Distance to Elem Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> � ay, Yes❑ NoR, Yes❑ No <br /> 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 /> FADEVSVGTIanning Application Forms} Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />