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PLICATION - LOT Ll Qi ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> k PROPOSED PARCELS <br /> f Existing Square Proposed Square <br /> Parcel Number t Existin or PTposed Use of Parcel Fooka a or Acrea a Foota a or Acrea e <br /> E 5 1 � f` /-T +MtG ► ��C�F��-� - r� 1�Er✓ ,37 ACr�S <br /> f <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed ❑ <br /> Existin ❑ <br /> Private Water 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 /> Existin ❑ <br /> On-site SewaMe <br /> Dis sal Existin Septic System <br /> New Se tic S tem El Other El <br /> Storm Drainage <br /> Public Storrs <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Required to: Ponds <br /> Proposed El <br /> Existing❑ <br /> Private St <br /> Draina On-site Retention Ponds Elra <br /> Natural Dina elNo Chane Other Ela <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elam <br /> Service Provider School S/ervice Provider Distance to Fire Station <br /> Lty, • QV11 f1; 0A Wff1`:7U I-I m t <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width CurblGutter Sidewalks <br /> i�'fLy`a 3 Yes❑ No 2�, Yes❑ No <br /> f 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❑ Yes❑ No❑ <br /> FADEVSVCIPIanning Application Forms) Page 4 of 7 <br /> Lot Line AdjustmenLdoa.(Revised 64-04) <br /> i <br />