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at,4!!IIP. APPLICATION - LOT LINE ADJUSTMENT <br /> a= y 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 /> OSS^ 390-�`� 14 W ev er; 11a.} c: C) I78 ;1' C <br /> d85 0-Q3 ( 44 w 1 F Qrhea <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 Required Sewer Facility <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewage <br /> Disposal Existin Septic S tem ® New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ 1 Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drainacie❑ On-site Retention Ponds ❑ Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> -P G_ ©/l S; i <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Lc7di Uhi re �l a � eZ � oa 1 OTttt <br /> Existing Roads <br /> Road/Street <br /> 1Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> C{ I.:, I'I�Ot'I T p C. R V� Yes L0 No❑ 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 /> FADEVSMPlanning Application ForrnM Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />