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�o =SANCATION -- LOT LIK ADJUSTMENT <br /> JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t <br /> FILE NUMBER: <br /> PROPOSED <br /> f PARCELS I <br /> Parcel Number Existin Fo <br /> or Pro sed Use of Parcel Existing Square Proposed Square <br /> ote a or Acrea a Footage or Acrea e <br /> oe S., 10, 5 �, � 4- <br /> ,- �, . . . f- <br /> 5 1 e p, <br /> Alor .5. <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> l <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Proposed❑ Required Water Feet <br /> Existing <br /> Private Water EAsting Well New Well Well Replacement ❑ <br /> Sewage Disposal ; <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider ewer Facility <br /> Proposed❑ Re uired S ; <br /> Existin <br /> On-site S wa e <br /> Dis osaz ExJsting Septic System New Septic S stem 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 /> Draina a 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 /> LOW-s/A e y47- 5�_ et- <br /> f <br /> School Servlce Fine Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider ' Distance to Fire Station <br /> . Existin Roads <br /> Road/Street Naive R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 4—' Yes❑ No Yes ❑ No <br /> Yes❑ No❑ Yes❑ No ❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewaiks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes ❑ No❑ <br /> F:1DEVSVCNPWnn1ng Mplkatlon Fonng% Page 4 of 7 <br /> Lot Line Adluv"entdoc,(Revised 6-4-04) <br /> i <br />