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APPLICATION - LOT LINE ADJUSTMENT <br /> ' Q ' <br /> 21t o� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N [ <br /> ^• FILE NUMBER: <br /> I I <br /> 4tik ii Rt' <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square ' <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Foota a or Acreage i <br /> cno�i-t -to �/rr`16'CEic+-O 1`4 - -L7 L-7. ILtp <br /> 003-11 -0`1 Vtrl E. A(L-O 3' �� • O>` <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 Water Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public',. <br /> Disposal Service Provider Re uired Sewer Facility <br /> Proposed ❑ <br /> Existing ❑ <br /> On-site Sewage <br /> Disposal ❑ Existing Septic 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 ❑ Reg uired to: Ponds <br /> Existing ❑ <br /> Private Storm <br /> Draina a On-site Retention Ponds ❑ Natural Drainage/No Chane Ig Other El i <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> Pfn1E <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station I <br /> L. A,' S�v-. 1 t7tat. 5 t-11 tcs <br /> Existing Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> _T�AA �; ¢el Yes El No CK Yes E] No <br /> Yes ❑ No ❑ Yes ❑ No ❑f <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 /> F10EVSMPlanning Application Fonns\ Page 4 of 7 <br /> Lot Line Adjustmentdac.(Revised 6-4-04) <br />