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'PLICATION - �CjT LII ADJUSTMENT. <br /> c SAN JOAQUIN COUNTYOMUNITY VELOPMENT DEPARTMENT <br /> FILE'NUMBER- <br /> k <br /> PR <br /> OPQSED PARCELS r ` <br /> Parcel NumberExisti or Proposed Use of Parcel existing Square Proposed Square <br /> - Foots a or Acre a Foots or Acres ei <br /> + ' <br /> y+ � EIA IR01 <br /> sr�t,e v �.;;ax��� Y. . ,d ���.. !.° 'fix .� �'rr +�. ' t i?:' s u •y �. • - <br /> Public Water ;Annex-Formation Distance to Public <br /> Proposed r] Service Provider Re aired <br /> Water Feel <br /> Existin z <br /> W <br /> } afar Ei'dstin 47 well � New Well � Ll ` <br /> Private W Well Re lacement <br /> Sewage Disposal h _� - ... <br /> Public sewage s' i <br /> DisposalAnnex-i`orination Distance to Public <br /> Proposed❑ Service Provider Requi Sewer Facili <br /> � Existin <br /> On-site Sewe e <br /> Ds sal Existi Se tic S stem New Se He S stem <br /> 11Other ❑ <br /> s <br /> Public Storm Storm Drainage <br /> } <br /> Drainage.. Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ R uired to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drains a On-site Retention Ponds ❑ Natural Me/No Chan e <br /> 4 Electricity ❑ Other <br /> Telephone Service <br /> Distance to - <br /> Service Provider Service Service Provider Distance to Service <br /> School Service •Fire.Protection Service <br /> Service Provider Distance to Eleni <br /> School Service Provider istance to Fire Station <br /> CA 1— rc. S <br /> � � Exisfjr� Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ NoZ Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> i <br /> Prosed 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 /> t ROEVSVOPlanning Application FormsN Page 4 of 7 <br /> Lot Line Adiust"InLdoc.(Revised 6-3.09) <br /> ' I <br /> t <br /> i <br />