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<br /> APPLICATIO , L4T.LINE"ADJUS:TMENT. .
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<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT..
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<br /> Parcel Number Existing or Proposed Use of parcel Existing Proposed
<br /> Square Footage, Square Footage or
<br /> or Acreage Acreage
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<br /> Public Water - _ Service Provider •. •� Annexformation Distance to Public '
<br /> Existing 0R ulred Water Feet
<br /> Proposed.ia
<br /> Private Water Exlstin Weil New well O Well Replacement O
<br /> 04
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<br /> Public Sewage Service Provider Annex-formation Distance to Public
<br /> Disposal R utred Sewer Facility
<br /> Existing 0
<br /> Proposed O
<br /> On-site SeVjUe Existing Septic System New Sepdc System O Other 0
<br /> Dfsoosal
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<br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-
<br /> Drainage Required to: Retention Ponds
<br /> Existing O
<br /> Proposed n
<br /> Private Storm On-site Retentlon Pond(s) O . Natural Drainage/No Change Other O
<br /> Drains a C]
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<br /> Service Provider Distance to Service' Service Provider Distance to Service
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<br /> Service Provider Distance to s ce Service Provider Distance to Service
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<br /> Service Provider Distance to Elem Service Provider Distance to Fire
<br /> School Station
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<br /> :.aa..,.1_xistin ..Reads hCC. ytn0}, ,., ?iri.
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<br /> Road/Street Name R.O.W.Width Pavement Width CurbMutter Sidewalks
<br /> ` S r Za l Yes fl Nox Yes❑ No)INIC
<br /> Yes O No O Yes❑ No.O
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<br /> :Oro' sed Roadi:... .. . • '.,... :... . :x .... s. ..
<br /> RoadlStreet Name_.__:-_ Pavement Width Curb(Gutter Sidewalks
<br /> Yes O No 0 Yes O No O
<br /> Yes 0 No Q - Yes O No 0
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