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PPLICATION - LST NE ADJUSTMENT <br /> " ` `' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMFNT <br /> ! I <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or.Pro osed Use of Parcel Footage or Acreage Foota e or Acrea e <br /> �I / T�s�-��c.t• �,`I. 1 .56 A-4-f/ S41-4 L�/ <br /> 21 <br /> ! <br /> _ SITE IMPROVEMENTS AND SERVICES - <br /> li -- Water <br /> �F-- Annex-Formation Distance to Fubiis <br /> ! Public Water Service Provider <br /> Required Water(Feet) <br /> Proposed ❑ <br /> ik' tin� ❑ <br /> r-------Fxis =----- — — --- <br /> E! <br /> i _ Private Water Existin Well New Well ❑ Well Re lacement ❑ <br /> - Sewage Disposal <br /> ' Public Sewage Annex-Formation Distance to Public <br /> li <br /> !� Disposal Service Provider Required Sewer Facilitv <br /> !; Proposed ❑ -- � <br /> e <br /> EE_-- <br /> Existing ❑_ — <br /> � On-site Sewage -- <br /> ;;_ _Disposal IExisting Septic System [ New Septic S stem <br /> �'— - _ p Y ❑ Other ❑- I <br /> � Storm Drainage ----- --v.--moi <br /> �j Puialic S#orm �� -- <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention II <br /> Proposed ❑ Required to: Ponds <br /> Existing <br /> Private Siorrn �_- <br /> -_ Drainage On-site Retention Ponds Natural Drainage/No Chan a [ Other ❑ II <br /> II <br /> Electrics_ tY Telephone Service <br /> r Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service i <br /> ! Distance to Elem <br /> Service ProviderSchool Service Provider Distance to Fire Station; <br /> !r— — — — <br /> I! <br /> Existing Roads _ <br /> E _ Road/Street Name i R.O.W. Width Pavement Width Curb/Gutter Sidewalks f <br /> €r <br /> Yes❑ No Yes ❑ No II <br /> Yes ❑ No❑ Yes No❑ �I <br /> , I <br /> i; Proposed Roads ! <br /> Road/Street Name R.O.W.Width Pavement Width <br /> Curb/Gutter Sidewalks <br /> Yes ❑ No❑ Yes ❑ No l �I <br /> Yes❑ No❑ Yes-❑ -<No <br /> 1i?FVSV(,P:annirg Application Forms\ -Page 4 of 7 <br /> L i Mme ad;lstrn=»t:Ucc.lFievisetl-6-4-04) <br />