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APPLICATION - LOT LINE ADJUSTMENT <br /> x•.�� p\ <br /> G4N.tpAQU1N COUNTY COMMUNITY f1FVFLOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> FOR <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existin or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> e / • / <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Proposed❑ Required Water Feet <br /> Existin / , �_ ,,V' /� <br /> V114-- o - <br /> Private Water Existin Well New Well Well Re lacement <br /> Sewage Disposal <br /> Public Sewage Sewage <br /> Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ 17 <br /> • r <br /> Existin / �-. E. ���-/JF.�-1 �"" A'�4- <br /> On-site Sewage <br /> Disposal❑ Existing Se tic System ❑ New Septic System LL Other <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed 171Required to: Ponds <br /> Existing❑ <br /> Private Stonp <br /> Drains On-site Retention Ponds _ Natural Drainage/No Change_ 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 tc Rem. <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/StreetName R.O.W.Width Pavement Width Curb/Gutter Sidewalks— <br /> V/ <br /> idewalksVEi2_r4-- ( V r <br /> °�= .�Z_i 1 Yes(�Pdo❑ Yes❑ Nv <br /> Yes❑ No❑ Yes❑ No❑ <br /> Pro osed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> AIIX N Yes❑ No Yes❑ NoU <br /> `i ✓LI✓A Yr <br /> Pgppe .R'rS r'� Zn/ µin: Yes No ID— Yes[I No a' <br /> F-4-:4 k <br /> ROEVSVOPlanning Application Forms\ Page 4 of 7 <br /> Lot Une AOWstment.cm.(Revise0 0511-091 <br />