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t vly APPLICATION — LOT LINE ADJUSTMENT <br /> 1•'.��ft A <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ( FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing r Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> IZ,VOO 4 <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed -1 <br /> Existing❑ <br /> Private Water❑ Existing Well [ New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re uired Sewer FacilitV <br /> Proposed❑ <br /> Existing❑ <br /> On-site Sewage <br /> Disposal❑ Existing Septic System bd 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 Provider Service Service Provider Distance to Service <br /> G4- ons4e <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Cyl LA s D 1 91 rin'ti•*_5 ccs I L4-hrLa4-hrw I X1 a m i e <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Oleanikir Q Yes ❑ No❑ 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 ❑ I Yes❑ No ❑ <br /> F:\DEVSVOPlanning Application Fonns\ Page 4 of 7 <br /> Lot Line Adjushnent.doc.(Revised 05-11-09) <br />