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APPLICATION -- LOT L. IE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUI....Y DEVELOPMENT DEPARTMENT <br /> r.' •� <br /> ' FILE NUMBER: <br /> wo <br /> iS ,;s,ri :;3 <br /> +N a �11 <br /> � :Yrt.a$� <rFM1C - ....Y. <br /> Existing Square Proposed Square <br /> Parcel Number Existingor Pro osed Use of Parcel Foota a or Acrea a �oota a or Acreage <br /> 0s 00 <br /> G � a <br /> + t ��ii ztl' xrfi + <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Re aired Water Feet <br /> Proposed❑ <br /> Existing ❑ <br /> Private Waterer Existing Well New Well ❑ Welk Replacement ❑ <br /> •'r.7=Annex-Formation <br /> Public Sewage Distance to Public <br /> Disposal Service Providerred Sewer Facility <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sewage <br /> Disposal ExistingSeptic System ElNew Septic System ❑ Other El <br /> 510"ill It- <br /> Public Storm <br /> Drainage Service Provider{if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> ❑ Re aired to: Ponds <br /> Proposed <br /> Existing❑ <br /> Private Storm <br /> Draina e❑ On-site Retention Pond s ❑ Natural a Mo Chane ❑ Other ❑ <br /> Natu Drainau <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> OWN' <br /> Distance to Elem <br /> vi r <br /> F <br /> Service Provider Distance to Fire Station <br /> i e Pro de <br /> Sery c <br /> Sc <br /> hoof <br /> RoadlStreet Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No Eg " Yes❑ No <br /> Ej­ <br /> Yes❑ No❑ Yes❑ No❑ <br /> .s <br /> RoadlStreet Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes No❑ Yes❑ Na❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> E <br />` FADEVSMPlanning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-o4) <br />