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R ~ + S <br /> QXT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT i <br /> Parcel Number Existing or Proposed Use of Parcel Existing Proposed <br /> Square Footage Square Footage or j <br /> orAcreage Acreage <br /> 70 7 <br /> 197 g�z <br /> x. ,4�, �2 <br /> NM <br /> MR <br /> 01 <br /> pn.nater Service Provider Annex-Formation Distance to Public <br /> xsng❑ Required Water(Feet) <br /> Proposed❑ <br /> Private Water Edsting Wall New Well ❑ Well Replacement ❑ <br /> Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal Required Sewer Facilfty <br /> Existing❑ <br /> Proposed❑ <br /> On-site Sewage Existing Septic System New Septic System ❑ Other ❑ <br /> Dlsposal <br /> 4 <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention- <br /> Drainage Required to. Retention Ponds <br /> Existing❑ <br /> Proposed O <br /> i <br /> Private Storm Onsite Retention Pond(s)❑ Natural Dralnage/No Change Other ❑ <br /> Drainage❑ <br /> M: Mir <br /> OWN <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> k <br /> Service Provider Distance to Service Service Provider Distance to Service <br /> e- <br /> Service Provider Distance to Elam Service Provider Distance to Fire <br /> School Station <br /> Zvi YIlO rji e 5 <br /> Road/Street Name R.O.W.Width Pavement Width CurWGutter Sidewalks <br /> Z Yes❑ No�8[ Yes O NoA <br /> �cr D l Yes❑ No)K Yes❑ Na <br /> z <br /> Roa&Straet Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No 0 Yes O No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> 1CtMAMPA_LA0$F@bw 1,100 <br /> -3- <br />