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APPLICATION - LOT LINE ADJ_ TMENT
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT L °ARTMENT
<br /> Parcel Number Existing or Proposed Use of Parcel ExistingProposed
<br /> posed
<br /> Square Footage Square Footage
<br /> or Acreage or Acreage
<br /> f�onnEs T� > 7r q H :�,O 4C-
<br /> oL D CHAR P I S,o c.
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<br /> �R�/10E5
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<br /> Public Water Service Provider Annex-Formation Distance to Public
<br /> Existing❑ Required Water(Feet)
<br /> Proposed❑
<br /> Private Water Existing Well ❑ New Well Well Replacement ❑.
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<br /> Public Sewage Service Provider Annex-Formation Distance to Public
<br /> Disposal Required Sewer Facility
<br /> Existing❑
<br /> Proposed❑
<br /> On-site Sewa a Existing Septic System ❑ New Septic System>( Other ❑
<br /> Disposal
<br /> .........
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<br /> Stor
<br /> Dtair"
<br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-
<br /> Drainage Required to: Retention Ponds
<br /> Existing❑
<br /> Proposed❑
<br /> Private Storm Onsite Retention Pond(s) ❑ Natural Drainage/No Change Other ❑
<br /> Drainage
<br /> Ct
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<br /> Service Provider Distance to Service Service Provider Distance to
<br /> Service
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<br /> Service Provider Distance to Service Service Provider Distance to
<br /> Service
<br /> C O A- Dn1 S i Tt- O E
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<br /> Service Provider Distance to Elem Service Provider Distance to Fire
<br /> School Station
<br /> Po %E 0 ) N r 111 a,,l 60,i SOL-o 0 �r7 /
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<br /> Road/Street Name R.00.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> y� U,2 14 /Z 17 J (' Yes❑ No� Yes❑ NoA-
<br /> /C i v evo, Yes❑ No Yes❑ NoA.
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> O Yes❑ No❑ Yes❑ No❑
<br /> Yes 0 No 0 Yes 13 No❑
<br />
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