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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER. <br /> fro <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Foota e or Acreage Foota e or Acreage <br /> L5_7—Z10 D,Ze ( 01Z6 prG <br /> 2.5l-ZRo- 2 o(a tor 0 &, L%2 c <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❑ <br /> Private Water c Existin 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 Sewage <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 ❑ <br /> Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Drainage On-site Retention Ponds ❑ Natural Draina e/No Chane Other ❑ <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 /> r ' `T` 2 LAS i n i LC- <br /> Existing <br /> CExistin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> m Pn1 CUJ7-?�_, 00taT Yes ❑ No K Yes ❑ No <br /> 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:\DEVSVC\Planning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />