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Service Facilities Needed City, Special District, etc. <br /> Water 4�5-/ s:rc U%czt <br /> Sewage .5/_5rtn9 S•J l „Y G 1crH �: <br /> Drainage Q- c„ F'Orr, ,x, r?. f.'. �•• .,,y fun[.c CcY s <br /> Electricity /✓�« Sr[ .vcc f `f' <br /> Gas Ive- <br /> What is the purpose of the proposed Line Line Adjustment: <br /> /? %/x-17- / d ,[�/SiC'�ii3c�7c:.0 <br /> O'c'-w--Q <br /> f3ncC /l9rfY E lc iA/n'E C%.l / !f <br /> Proposed property size and use: <br /> Parcel A size:_1 . J 9C� 'k-E�, use: <Z-;1/5r&P, ;e—e <br /> Parcel B size: .T- 3 - `J 6 YG- A e � use: L4C,f` <br /> Parcel C size: use: <br /> Parcel D size: --use: <br /> SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Owner (,s') (All owners must sign as their names appear on the <br /> deed. ) , <br /> F] Corporate Officer (s ) empowered to sign for the corporation, <br /> L---I Owner 's legal agent having Power of Attorney for this action (a <br /> notarized Power of Attorney document must accompany the <br /> application ) , <br /> and that the foregoing is true and correct. <br /> (S • ature ) /� (Date <br /> r <br /> (Signature ) (Da e ) <br /> (Signature ) (Date ) <br /> (Signature ) (Date) <br /> Lot Line Adjustment - 6 - ( 7/84 ) <br />