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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existin or Proposed Use of Parcel Footage or Acreage Foote a or Acrea e <br /> / i N � CeS ' L✓v'� / t <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> PubNc Water Service Provider _ R uired Water Feet <br /> Proposed❑ <br /> Existing _._ <br /> Private Water Existin Well New Well ❑ Weil Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal <br /> Service Provider R uired Sewer Facilitv <br /> Proposed❑ <br /> Existi ❑ <br /> On-site Sewa e <br /> Dis osal Existin Septic System New Septic System El Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) exex Ann -Formation Terminal Drainage Detention-Retention <br /> Required to: Ponds <br /> Proposed❑ <br /> Existing❑ <br /> Private Storm Natural Drainage/No Chane Other ❑ <br /> DrainageOn-site Retention Ponds ❑ <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 Service Provider Distance to Fire Station <br /> Service Provider School <br /> Existin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> / 2 I Yes❑ NojK Yes❑ No <br /> U O Q Yes ❑ No❑ Yes❑ No❑ <br /> Pro sed Roads <br /> RoadlStreet Name R.O.W.Width Pavement Width Cu /Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> Page 4 of 7 <br /> F:\DEVSVC\Planning Appllcatlon Forms\ <br /> Lot Line Adluelment.doa(Revised 05-11-W <br />