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x4PR t•F , .:IPLICATION - LOT Li, 4E ADJUSTMENT <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FiLE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existingor Pro osed Use of Parcel Foote a or Acrea a Foote a or Acreage <br /> er � � 6 <br /> 3 6o. <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Ann tion Distance to Public <br /> Public Water Service Provider Re uired Water Feet <br /> Proposed ❑ <br /> Existing <br /> Private Wateixisting Well New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Existin ❑ <br /> On-site Sewa e <br /> Disposal'Disposal'o 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 /> Drainage❑ On-site Retention Ponds ❑ Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Pro ider Service Service Provider Distance to Wvice <br /> 1 e9/1 —51 /7 — Si Pi <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provi er Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O./W.Width Pavement Width Curb/Gutter Sidewalks <br /> h e- a r0 Yes ❑ No Yes❑ No <br /> ,494W&l Qri1 219 ( Yes ❑ No Yes ❑ No <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No ❑ <br /> Yes ❑ No❑ Yes ❑ No ❑ <br /> F?DEVSVCV'lanning Application Forms\ Page 4 of 7 <br /> Lot Line AdjustmentAm.(Revised 6.3-03) <br />