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APPLICATION- MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Parcel Number Existing or Proposed Use of Parcel Square Footage <br /> or Acr*age <br /> SI1' IMRROV MINT ,AND SERVICES . <br /> Public Water Sen ice Provider Annex-Formation Distance to Public Water <br /> Existing❑ Required Feet <br /> Proposed C <br /> Private Water Existing Well New Well Well Replacement O <br /> Public Sewage Service Provider Annex-Formation Distance to Public Sewer <br /> Disposal Re uired Facility <br /> Existing❑ <br /> Proposed❑ <br /> Onsite Sew a Existing Septic System ❑ New Septic System Other ❑ <br /> Dis osal <br /> Sform Dra(na e <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-Retention Ponds <br /> Drainage Required to: <br /> Existing❑ <br /> Proposed❑ <br /> Private Storm On-site Retention Pond(s) t� Natural Drainage/No Change Other <br /> Drainage <br /> Electricity Natural Gas <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> Telephone Service Cable::Teleision Service <br /> > . <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> 1� <br /> School Service Fire Protectlon Service <br /> Service Provider Distance to Elem Service Provider Distance to Fire Station <br /> / School <br /> Q'YL r e <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No t// Yes❑ No <br /> Yes❑ No Yes❑ No <br /> P..ro "seif'Roadc <br /> RoacUStreet Name R.O.W.Width PavementW9dth Cur!)/Gijtter Sidewalks <br /> Yes❑ No❑ Yes❑ No O <br /> Yes❑ No❑ Yes O No❑ <br /> -3- <br />