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". .r-PLICATION -- LOT LOSE ADJUSTMENT <br /> -T SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> tn: { <br /> FILE NUMBER: <br /> P <br /> P00,9#1D PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existin or Pro osed Use of Parcel Footage or Acrea eFoota e or Acrea e <br /> /' y C A 3 <br /> C_ <br /> SITE IMPROVEMENTS.AhD SERVICES <br /> .Wa#er <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider <br /> Proposed ElRequired Water Feei <br /> i=XiSfln ❑ <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 Facili <br /> Proposed ❑ <br /> Existin[7 ❑ <br /> On-site Sewage <br /> Dis osal Existing Septic System- 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 /> lk r de' 5 / e <br /> School Service Fire Protection Service <br /> Distance to Eiem <br /> Service Provider School Service Provider Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O,W•Width Pavement Width Curb/Gutter Sidewalks <br /> e Z �O _32- / Yes ❑ No Yes ❑ No <br /> f.C�Ca z¢ Yes EDNo Yes L] 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 /> F.IDEVSVC'.Plann;ng Application Forms\ Page 4 of 7 <br /> Lei Line Ad uscment.doc. (Revised 6-3-03) <br />