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x 4 - <br /> ��� .. Ai,: ACATION -- LOT LINA: P+DJUSTMENT <br /> SAN JOA <br /> QUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _ FILE NUMBER: <br /> PROPOSED PARCELS <br /> Parcel Number Existing Square Proposed7,ea <br /> Existin o Pro used Use of Parcel Foota a or Acrea a Foota a o <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public WaterE Service Provider Annex-Formation Distance to Public <br /> Proposed❑ Required Water Feet <br /> Existin ❑ <br /> Private Water Existin Well01 <br /> New Well ❑ Well Re iacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider <br /> Proposed F1Re uired Sewer Facili <br /> Existin ❑ <br /> On-site Se agie <br /> Dis osal Exist!n Se tic system New Septic System ❑ 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 /> :L LDralnaqe <br /> te St <br /> On-site Retention Ponds ❑ Natural Draina e1No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> Nu=10 <br /> School Service Fire Protection Service + <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Me= glu O rnLun <br /> Existina Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ NoDf- Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter LONo <br /> Yes❑ No❑ YYes❑ No❑ Y <br /> F,WEVSVCLPIanning Application Formsl Page 4 cf 7 <br /> Lot Line Adjuatrnentdoc.(Revised 6-4-04) <br />