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'PLICATION - LOT LIE ADJUSTMENT <br /> ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPAJZT-!'JIENT <br /> FILE NUMBER: <br /> •IFOR�`P <br /> PRO.QQSEC� PARCELS <br /> . ..,...., <br /> Existing Square Proposed Square <br /> Parcel Number Existin or Proposed Use of Parcel -Foots a orAcrea e_., Footage or Acreage <br /> '. 3as,, 4 !..', t} <br /> qua�❑. = , <br /> - - 1...�� <br /> T s z s <br /> Annex-Formation Distance to public, <br /> Public Water Service Provider ;Re uired Water Feet <br /> Proposed❑ <br /> Existin ❑. <br /> E Private:Water C Existinq Well New Well ❑ Well Replacement ❑ <br /> ` _ S�leage'.DiSpo��l y,. <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 S stem ® New Septic S stem Other ❑ <br /> S6rm°i3rainage . <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 /> Drains 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 /> School Service Fire Protection Service. <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Ld i v-t i i S� 3l4 Y''► n�: F` en v ;_p ev-t i <br /> Existing Roads <br /> i Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> t at % ? Yes❑ No ® Yes❑ No 0 <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> N m Yes❑ No ❑ Yes❑ No❑ <br /> Yes ❑ No❑ Yes❑ No❑ <br /> F:IDEVSVC\PIanning App4ication Forms\ Page 4 of 7 <br /> Lot Line Adjustment,doc.(Revised 6-3-03) <br />�1 <br /> l <br />