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APPLICATION ' <br /> F -� LOT LINE ADJUSTMENT <br /> A SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> X <br /> FILE NUMBER: <br /> PROPOSED-PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existingor Proposed Use of Parcel Foots lge e-1; or Acres a Footage or Acreage <br /> s8 <br /> �^e_ Q a <br /> SITE]IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water fFeelL <br /> Proposed❑ <br /> Existing ElPrivate Water Existing Well New Well Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facilit <br /> Proposed❑ <br /> Existin ❑ <br /> On-site Sew a e <br /> Disposal ExistingSeptic S stem . New Se tic S tem El _...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 DrainagNo Chane Other ❑ <br /> 'Electricity Telephone Service <br /> Distance to <br /> Service Providers Service Service Provider Distance to Service <br /> C 1AT <br /> School Service ire Protection Service <br /> Distance to Elem <br /> Service Provider School Se 'ce Provider Distance to Fire Station <br /> Existin" Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> GtGk 0iI 2¢ Yes❑ No Yes❑ No <br /> (a Yes❑ No Yes LlNo[j <br /> PTposed 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:SDEVSVC%PIanning Application Formsl Page 4 of 7 <br /> Lot Line AdlustmentAm.(Revised 05-11-09) <br />