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F°U'N APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUP 'DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> A�!FOR��P <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footacie or Acreage <br /> t�Ou �c� 4 �i Ct.Ci �� c. -17-1_ <br /> Cfp0t, 2(0 qq. -t + <br /> eA-60►gal 4 Cor q .ci /-Cir <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 ❑ <br /> Private Watern 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 /> E <br /> xisting ❑ <br /> Sewage <br /> osal Existing Septic System ® New Septic System ❑ OtherStorm Drainage <br /> lic Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Required to: Ponds <br /> ExistingF ❑ <br /> Private Storm <br /> Draina e'er 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 /> C On <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> E5CCt1�n nr rn; 1e5 toy S <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> fiA, t d Q a Yes ❑ No g Yes❑ No <br /> f Db M 0 Yes ❑ No 9 Yes❑ Noj� <br /> Proposed Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F:\DEVSVC\Planning Application Fortes\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />