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,tl APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAC;UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> -� FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acre e <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing❑ <br /> Private Water❑ Existing Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re uired Sevrer Facility <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewage �.. <br /> Disposal 17 Existing Septic S stem New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drainage❑ On-site Retention Pond s ❑ Natural Draina a/No Chane O[her ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distanqe to Service <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider Service Provider Distance to Fire Station <br /> /. <br /> Existing Roads <br /> Road/StreetName R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ NoXI Yes❑ NoJEL <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> !- Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> FiDEVSVOPlanning Application Foms\ Page 4 of 7 <br /> Lot Line Adlustrnentdoc.(Revised 05-1109) <br />