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a,{ " APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ei < <br /> FILE NUMBER: <br /> PRO .SEQ PARCELS <br /> Parcel NumberExlGn or Pro axed Use of Parcel Existing Square Proposed Square <br /> / MK is Foots e1or Acres a Foots eor Acres e <br /> 1�-�- <br /> 3 <br /> SITE. gnryq SERVICES',, <br /> Water <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Proposed 171 Service <br /> ulred <br /> Existln <br /> ❑ Water Feet <br /> Private Water Existin Well <br /> New Well Well Replacement <br /> Sewage Disposal ID <br /> Public Sewage <br /> Disposal Service Provider Annex-Formation Distance to Public <br /> Proposed 177 Re ulred Sewer Facili <br /> Existln ❑ <br /> On-site Sew ge <br /> Dis osal Existin Sac—tic S stem <br /> New Septic System V Other ❑ <br /> Public Storm Storm Drainage <br /> Drainage Service Provider(It Public) Annex-Formation Terminal Drains a Detention- <br /> Proposed❑ Re ulred g Retention <br /> Existing❑ to: Ponds <br /> Private Storm <br /> Draina a On-slte Retention Pond s Natural Drnlna a/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider <br /> Distance to Service <br /> - e_ SB G i e_ <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> 01.4 <' <br /> Existln Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter <br /> U � �G✓� ' D r . Sidewalks <br /> r <br /> Yes❑ NoK Yes ❑ No($ <br /> Yes ❑ No❑ Yes ❑ No ❑ <br /> Pro osatl Road& <br /> Road/Street Name R_O.W.Wldlh Pavement Width Curb/Gutter <br /> Sidewalks <br /> Yes ❑ No❑ Yes ❑ No [] <br /> Yea❑ No❑ Yes ❑ No ❑ <br /> F:10EVSVC�Wnreng Agglealion Formsl Page 4 of 7 <br /> Loi Line Adjul"W d".(Reviled BJ-03) <br /> £0 39t+r1 17q T74 �i nlnua <br /> rlov <br />