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Pa�!N APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> q<,FOR��P <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existin <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 Sewer Facility <br /> Proposed❑ <br /> Existing E;— »`e d <br /> On-site Sewage <br /> Disposal Existing Septic System [S 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 Ponds ❑ Natural Drainage/No Chane Other ❑ <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 <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> l'J''Ll_t,'ttJ -5722-EVE-t— -SLJ� �� Yes❑ No N Yes❑ No R <br /> Yes❑ No a Yes❑ No <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> A) Yes❑ No❑ Yes❑ No❑ <br /> tl Yes❑ No❑ Yes❑ No❑ <br /> F:\DEVSVC\Planning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />