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APPLICATION- MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> X. <br /> X. <br /> ASO <br /> Parcel Number Existing or Proposed Use of Parcel Square Footage <br /> or Acreage <br /> "� U�� . yr v • t -� rnr i C U <br /> P r 7`r <br /> :> <br /> :: ;:: .:::.. <br /> :..:.:.:... ............................................. :....V>~MENT.S.:AN'p.SE.RYlCES:......:::::..;::»:::;;.>:<::»:<:::;:::>:<:;: >:<:;:::<:>::>::>....:...... <br /> Public Water Service Provider Annex-Formation Distance to Public <br /> Existing❑ Required Water (Feet) <br /> Proposed❑ <br /> Private Water Er Existing Well Q- New Well ❑ Well Replacement ❑ <br /> posa <br /> Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal Required Sewer Facility <br /> Existing ❑ <br /> Proposed ❑ <br /> On-site Sewage Existing Septic System Er New Septic System ❑ Other ❑ <br /> Disposal B <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention- <br /> Drainage Required to: Retention Ponds <br /> Existing ❑ <br /> Proposed ❑ <br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change � Other ❑ <br /> Drainage U- <br /> Service Provider Distance to Service Service Provider Distance to <br /> Service <br /> :.... <br /> A.ph..h.......rxic.......::::::....::::::::::::::::::: .;;:;;;>;;:>. >;Ga6 sFelevisin <br /> Service Provider Distance to Service Service Provider Distance to <br /> ,fes • J Service <br /> 7"c� C Yi St 1`-e <br /> >: ::.:. <br /> .:...:..:.;...:..,.....::....:.....::..:.... oo $ ¢:>;;:;:;.::::.;:..;:... Fite::#'totectiott Sh(Ine <br /> Service Provider Distance to Elem Service Provider Distance to Fire <br /> School Station <br /> 1;1 �� •7 - 7, f'r s <br /> ::::;:::.::.: g.. ..>:as.:::::::::....::. .. ...... <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> ll>Z l f&,Cvc'' Ct �C Yes❑ No MK Yes ❑ No 0- <br /> f C wj �r „2 Yes❑ No(,4- Yes❑ No Gf— <br /> :p <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No❑ Yes ❑ No ❑ <br /> Yes❑ No❑ Yes ❑ No❑ <br /> -3- <br />