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aAq�IN' APPLICATION — LOT LINE ADJUSTMENT <br /> Q' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N: X <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existingor Proposed Use of Parcel Foota e or Acreage -Footage or Acreage <br /> / Ex�Sriiyg �Or7vcF D� 5 +c_ %, Z5"AC- <br /> V A--C 4rT- 3 A C- y z5 A-c.. <br /> ✓A- A L oo Ac <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 Waterer 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 /> Existing ❑ <br /> On-site Sewage <br /> Disposal Existing Septic System Pl- 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 Drainage/No Change ,2- Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> 6 F Av- 5ew- S1TE <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> i <br /> Road/Street Name I R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> _S5 c A i,vi - Yes❑ No - Yes❑ No f!�_ <br /> Yes❑ No❑ Yes❑ No <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Widih Curb/Gutter Sidewalks <br /> Yes ❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> F:\DEVSVC\Planning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />