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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> gl,�i <br /> Square Froposed <br /> Parr-ell NumberExisting or Proposed Use of Parcel Foota floor Acrea a Foote a or AcresSquare e <br /> �4 _56 - <br /> -5 Z 4-<, <br /> I Ke /dc� ce_ e a« e r <br /> 1 111111, HIS <br /> Public WaterService Provider Annex-Formation Distance to P blic <br /> Proposed Ll Re ujred Water Feet <br /> Existin 1-1 <br /> Private W ter*9 E)iligng2i'll)-111111 New Well El Well Replacement El <br /> Hill <br /> v <br /> If, In <br /> 11 1 hj <br /> 'Im , 1 .1 1 � 411 1 <br /> Sewage Annex-Formation Distance to Public <br /> Public S h' 4, , <br /> Disposal Service Provider Required Sewer Facilit <br /> Proposed El <br /> Existing <br /> On-site Se a <br /> DisposaI7 Exis tin I : i itici;: ew Se tic 8 tern ❑ Other E] <br /> M �ri 'gl 1, <br /> Public Storm <br /> Drainage Service Provider(if Pu;blicq) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed El Re uired to: Ponds <br /> Existing El <br /> Private Storm <br /> Draina a 0 On-site Retention Pond(s) ❑ Natural Drain /No Chan a Other <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> u; <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Static, <br /> gall jo, Er <br /> ilij ^7 1 <br /> ,ip"!i."ihd <br /> Road/Street Name R.O.W.Width Pavement Width Cu utter Sidewalks <br /> Z, /0"If Z7 U__ M , <br /> YO <br /> es Lj NoJN Yes E-1 No Cy-- <br /> [Ali <br /> All <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> EHHE <br /> F:\l3EVSVC1Plannlng Application Porms\ Page 4 of 7 <br /> Lot Line Adjustment.doc. (Revised 05.11-09) <br />