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xw + .iN 0..9- i>Yt.co - f�u PLICATION - LOT L , .E ADJUSTMENT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: PRO.P,_SEDT ELS Existing Square Proposed Square Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage 2 _4Z { 2 3 /455 SITE IMPROVEMtNTS ANN SERVICES Water Annex-Formation Distance to Public Public Water Service Provider Required Water Feet Proposed❑ Existing ❑ Private Water Existing Well ❑ New Well Well Replacement ❑ Sewage Disposal Public Sewage Annex-Formation Distance to Public Disposal Service Provider Required Sewer Facility Proposed❑ Existing ❑ On-site Sewage Dis osal Existing Septic Sstem ❑ New Septic System Other ❑ Storm Drainage Public Storm i Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention Proposed ❑ Required to: Ponds Existing ❑ Private Storm Drains e On-site Retention Ponds ❑ Natural Drains e1No Chane Other ❑ Electricity Telephone Service Distance to Service Provider Service Service Provider Distance to Service School Service Fire Protection Service Distance to Elem Service ProviderSchool ervice Provider Distance to Fire Station Existing Roads f Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks Yes El No Yes [_1 No E Yes ❑ No ❑ Yes ❑ No ❑ Proposed Roads Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewaiks Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ F.\DEVSVC\P anning Application Forms\ Page 4 of 7 Lot Line Adjustmenl,doc.(Revised 6-3-03)