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<br /> M Lr_1' LINE ADJUSTMENT
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Parcel Number Existing or Proposed Use of Parcel Existing Proposed
<br /> Square Footage Square Footage
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<br /> Public W. Service Provider Annex-Formation Distance to Public
<br /> Required Water(Feet)
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<br /> Proposed❑ , /
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<br /> Private,�Water❑ Existing Well ❑
<br /> New Wolf 13 Wel!Replacement ❑
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<br /> Service Provider Annex-Formation Distance Facility Public Sewage Required Sewer Faa cility
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<br /> Existin ` A/
<br /> Propos
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<br /> On-site Sewage Existing Septic System ❑ New Septic System 0 Other 11
<br /> Disposal❑ r t +t 1 v tea#"Tff
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<br /> ;i Annex-Formation Terminal Drainage Detention-
<br /> Public Storm Service Provider to: Retention Ponds
<br /> Drainage Required
<br /> Existing
<br /> Proposed
<br /> On-site R entian Pond(s)13 Natural Drainage/NO Change ❑ Other ❑
<br /> Private Storm
<br /> Drainage❑ :txa
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<br /> Service Provider Distance to
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<br /> :r Service Provider Service
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<br /> Er a TelephryneServlce ?�
<br /> Service Provide Service
<br /> Distance to
<br /> A Distance to Service Provider
<br /> Provider
<br /> Service
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<br /> �5choul SdrvfC.e� �� �jg,� r { Distance to Fire
<br /> € Distance to Efern Service Provider Station
<br /> Service Provider School
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<br /> Road/Street Name R.O./W. Width pavement Width
<br /> Curb/Gutter Sidewalks
<br /> [d Z 0 , YeA No❑ Yes No❑
<br /> Yes❑ No❑ Yes❑ No❑
<br /> -r----n. !l�_._•��- - yrs a fs,e a�'.-d'zi�Va $ '{�ci1R;?iw ',�. hf�� 31r r'9+ �t f 4 `y'Yr/ti ! r,: w.
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<br /> ' °� Curb/Gutter Sidewalks
<br /> , R.O.W. Width PavemenE Width
<br /> Road/Street Name 0
<br /> Yes❑ No❑ Yes❑ No
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<br /> Yes 0 No❑ Yes❑ No❑
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<br /> f 1!1 PMPA_LA95 FehmAry 1,1999 -3-
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