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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PROPOSED PARCELS <br /> Parcel Number Existing or Proposed Use of Parcel Square Footage <br /> or Acreage <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water /`fON� <br /> Public Water Service Provider Annex-Formation Distance to Public Water <br /> Existing o <br /> Proposed o Required (Feet) <br /> [:Private Water o Existing Well o New Well o Well Replacement o <br /> Sewage Disposal AV <br /> Public Sewage Service Provider Annex-Formation Distance to Public Sewer <br /> Disposal <br /> Existing o Required Facility <br /> Proposed o <br /> On-site Sewage Existing Septic System o New Septic System o Other o <br /> Disposal o <br /> Storm Drainage / <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-Retention Ponds <br /> Drainage Required to: <br /> Existing o <br /> Proposed o <br /> Private Storm On-site Retention Pond(s) o Natural Drainage/No Change b Other o <br /> Drainage o <br /> Electricity Natural Gas ,, <br /> Service Provider Distance to Service Provider Distance to Service <br /> Service <br /> Telephone Service Cable Television Service <br /> Service Provider Distance to Service Provider Distance to Service <br /> Service <br /> 2 L cC [G UZ �7 7- �L <br /> School Service Fire Protection Service <br /> Service Provider Distance to E/em Service Provider Distance to Fire Station <br /> School <br /> f f. Y- /'ti_ r <br /> Existing Roads <br /> Road/Street Name R.0.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Yes o No A Yes o No)o <br /> Yes o No o Yes o No o <br /> Pro osed Roads <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> Yes No Yes No <br /> Yes o No o Yes o No o <br /> MINORSUBAPP FORM REV. E-10-01 )I140) <br /> -3- <br />