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a <br /> PLICATION — LOT LSE ADJUSTMENT a <br /> �ti SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT . <br /> .A <br /> FILE NUMBER: <br /> tri oR�� <br /> a n PiO <br /> ,:rRO SI=1DPAiZCEL°S �r4 - Y t <br /> .. Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel - Footage or Acreage Footage or Acreage <br /> •c n s� Fv` = s x r-'silF a ro "^cam <br /> k � 4 SITE�MPR01lEMNTS AND.S1E=R11ICES <br /> -- F 1 I <br /> s i � _ '.�'• �"� � r � Vlfater,i� �-' w ��yF� - •:1a � r E-+- <br /> Annex-Formation Distance to Public ~ <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> Private Watej& 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 /> F_05n�-site Sewa e <br /> s asal Existin Septic S stem New Septic System Other ❑ <br /> Storm Drairiage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing[I <br /> Private Storm <br /> Drainage On-site Retention Ponds Natural Drainage/No Chane ❑ Other E] <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> to 4— <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to l=ire Station <br /> AJ C <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> S ' `2 ( r Yes❑ No I_ Yes❑ No(& <br /> f Yes ❑ No Lia– Yes ❑ No S <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> PO Yes ❑ No ❑ Yes ❑ No ❑ <br /> Yes ❑ No ❑ Yes ❑ No ❑ <br /> F:IDEVSVC\Planning Application Forms\ Page 4 of 7 <br /> Lot Line Adjustmenl.doc.(Revised 6-3-03) <br />