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` PPLICATION -- LOT LNE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number <br /> Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> X <br /> 114'a v AJ YA" G 1-7, 93 4c, <br /> rAA /i!ES/O€WA�Z V/(t16_y4A4Q <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existing F.,'�_ <br /> [—private Water. Existing 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 /> Existing ❑ <br /> On-site Sewage <br /> Dis osal 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 Change� Other:E:]:] <br /> Electricity Telephone Service. <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads. <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No E�j- Yes ❑ No R <br /> Yes ❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> I <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No Yes ❑ No E . <br /> Yes ❑ No❑ Yes ❑ No ❑ <br /> F:\DEvsvcrPianning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />