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oP4�IN.. APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> a: < <br /> FILE NUMBER: <br /> 9[iFoa�'• <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <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 s-r aEA 1 <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 /> Existin a�- �� �a <br /> On-site Sewage New Septic System El Other [jDisposal El Existing Septic System El <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& 7Z5— da P.la <br /> Private Storm <br /> Draina e❑ 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 /> School Seryl F Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> LAc; a . <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> fir; v 5a ' D Yes ® No ❑ Yes ❑ Nola <br /> Yes ❑ No ❑ Yes ❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> N Yes ❑ No❑ Yes ❑ No❑ <br /> Yes ❑ No ❑ Yes ❑ No❑ <br /> FADEVSMPlanning Application Forms\ Page 4 of 7 <br /> Lot Line Ad)ustrnentdoc.(Revised 05-11-09) <br />