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<br />      							}PLICATION - LOT  LSE ADJUSTMENT
<br />     								SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
<br />   	:n.      	X
<br />   	` 												FILE NUMBER:
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<br />    														Existing Square 	Proposed Square
<br />		Parcel Number
<br />      						Existing or Proposed Use of Parcel   		Footacle or Acreage     Footage or Acreage
<br />			1       	Agriculture with residence									2.20 ac gross
<br />       		2       	Agriculture      											7.80 ac
<br />			3       	Agriculture with residence       								51.48 ac gross
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<br />    														Annex-Formation       Distance to Public
<br /> 		Public Water  				Service Provider     				Required       	Water Feet
<br /> 		Proposed ❑
<br />  		Existing❑
<br />   					ii
<br />      	Private Water®    		Existing Well ®      		New Well ❑     		Well Re lacement ❑
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<br />       	Public Sewage    										Annex-Formation       Distance to Public
<br />   		Disposal    				Service Provider     				Re uired      	Sewer Facility
<br /> 		Proposed ❑
<br />  		Existin  ❑
<br />       	On-site Sewage
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<br /> 		Disposal®  __T	Existing Septic S stem
<br />     									®       			New Septic System	Other
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<br />   		Drainage 		Service Provider(if Public)    	Annex-Formation      Terminal Drainage     Detention-Retention
<br /> 		Proposed ❑       							Required    		to:       		Ponds
<br />  		Existing❑
<br />		Private Storm
<br /> 		Drainage ®    	I      On-site Retention Ponds  ❑       		Natural Drainage/No Chane ®	Other ❑
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<br />   							Distance to
<br />       		Service Provider `' 		Service      		Service Provider			Distance to Service
<br />     			PG&E			Existing    			SBC     				Existing
<br />  							.e W
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<br />   					i�    	Distance to Elem
<br />       		Service Provider    		School      		Service Provider      		Distance to Fire Station
<br />       		Escalon Unified '   		3 mi      			Ripon       				2 mi
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<br />  									; ?s..   ��sti'.) :Roads
<br /> 									-   ..     	:
<br />  				Road/Street Name 			R.O.W.Width    Pavement Width       Curb/Gutter  	Sidewalks
<br />    				Wagner Road 				40'    	26' (estimate)      Yes ❑  No®      Yes❑  No
<br />   												-6ft,   €€     ....   					i       , 1s3[-
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<br />  				Load/Street Name 			R.O.W.Width    Pavement Width       Curb/Gutter  	Sidewalks
<br />  					N/A      									Yes❑  No❑      Yes❑  No ❑
<br />     															Yes ❑  No❑      Yes ❑  No❑
<br />   	F”DEVSVCIPlanning Application Formsl       				Page 2 of 3  					Job No 2007-56 LLA.doc
<br />   	Lot Line Adjustment.doc.(Revised 6-4-04)
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