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y. �2�,. f ""_ .'LICATION - LOT L ADJUSTMENT Ei SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: ' R�fi`agi3� i I ` PROPOSED.PARCELS Existing Square Proposed Square I Parcel Number Existing or Propos d Use of Parcel Fopta a or Acreage Footage or Acreage 2r .5 02 Ci r'' to 7rr�. � -' 4� X25 PAC— �j SITE.IMPROVEMENTS AND SERVICES f E Water. Annex-Formation Distance to Public Proposed r-1Public Water Service Provider Required Water Feet Existing❑ Private Water �4 �. Existing Well New Well Well Replacement El I Sewage Disposal Public Sewage Disposal Service Provider Annex-Formation Distance to Public � " Proposed[IRequired Sewer Facility. I Existing Elpi On-site Sewage f1 Disposal Existing Septic System New Septic System Other ❑ } Storm Drainage 11 Public Storm Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention Proposed❑ Required to: Ponds Existing❑ Private Storm Dralna a On-site Retention Ponds ❑ Natural Drains a/No Change Other',❑ I Electricity Telephone Service Distance to Service Provider Service Service Provider d Distance to Service E{ � � tee.!-S��> �T •-�" 4�- S i?� School Service Fire Protection Service €� Distance to Eleni i Service Provider School Service Provider Distance to Fire Station � F— Existin Roads Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks Go 2-0 Yes❑ No® Yes El No 0 �i Yes❑ No❑ Yes❑ No❑ i Pro osed Roads Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks �I Yes❑ No❑ Yes❑ No❑ Yes❑ No❑ Yes❑ No❑ p F:1DEVSVC1PIanning Application Formsl Page 4 0f 7 i Lot Line Adjcstment.doc.(Revised 6-44-04) I