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�In 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 Existinq or Proposed Use of Parcel Footage or Acreage Foots a or Acres e <br /> ovse. 5e, " 35. <br /> Z os re 57 52 <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 Existin2 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 Existinq 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 ❑ On-site Retention Ponds ❑ Natural Drains a/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> *7 ,'/,10 n 1 rl <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Cu Gutter Sidewalks <br /> G0 5 ¢O 'Z Yes❑ No,® Yes❑ No la <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 /> FADEvsvctPfa.n nj Application Forms% Page 4 of 7 <br /> Lot Line Adjustment,doc.(Revised 05-11-09) <br />