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APPLICATION- MINOR SUBDIVISION
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Parcel Number Existing or Proposed Use of Parcel Square Footage
<br /> or Acreage
<br /> 5- acre-
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<br /> Public Water Service Provider Annex-Formation Distance to Public
<br /> Existing❑ Required Water(Feet)
<br /> Proposed❑
<br /> Private Wats Existing Well New Well Well Replacement ❑
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<br /> Public Sewage Servioe Provider Annex-Formation Distance to Public
<br /> Disposal Required Sewer Facility
<br /> Existing❑
<br /> Proposed❑
<br /> On-ske Sewa a Existing Septic System New Septic System Other ❑
<br /> Disposal
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<br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-
<br /> Drainage Required to: Retention Ponds
<br /> Existing❑
<br /> Proposed❑
<br /> Private Storm Or-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑
<br /> Drainage❑
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<br /> Service Provider Distance to Service Service Provider Distance to
<br /> Service
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<br /> Service
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<br /> Service Provider Distance to Elem Service Provider Distance to Fire
<br /> School Station
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
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<br /> -3-
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