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' Pp •so r%PPLICATION - LUT (""4 <br /> E ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :K <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existina or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> L 4e .7 <br /> Inevoed <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public Water Annex-Formation Distance to Public <br /> Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing <br /> Private Water ExistingWell ❑ New Well Well Re acement <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Existing <br /> On-site Se e <br /> Disposal Existing Septic System ❑ 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 /> Drains a On-site Retention Ponds "Natural Drains elNo Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> s6� 400e , rr <br /> School Service Fire Protection Service <br /> Distance to Elam <br /> Service Provider School Service Provider ' Distance to Fire Station <br /> FRoad/Street <br /> I G Exlstin Roads <br /> oadtStreet Name R.O.W.Width Pavement Width CurblGutter Sidewalks <br /> Q � fYes[:INo Yes❑ No'® <br /> f r Yes ElNo€�. Yes F-1NoPro osed Roads <br /> Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> F.,MEVSVCF1annin9 Application Formal Page 4 of 7 <br /> Lot une Adiushnent dw_(Revised 6-4-04) <br /> r <br /> I <br />