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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTFWAVATION:BIfOI!1ATUR <br /> ONLY THE OWNER OF YHE PROPEFi'P1'OR A111*� v rbiCl[N,r MAY i ILF,AND AFPiJCATIfNN. <br /> SIGNATURE: I certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner,trustee, trurtor, or corporate officer) of the property($) <br /> involved In this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and <br /> that the foregoing application statements are true and correct. <br /> Siprradure: Daily: <br /> SilpralLuria: DMD: <br /> SlUrnurre: DEW <br /> Siprradwe: Do <br /> APPLICATION- MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PPOPOUOVARMLS <br /> Parcel Number Existing or Proposed Use of Parcel Square Footage <br /> or Acreage <br /> r!l6rril revytv`r f os 5,r Le-_ - <br /> i <br /> SITE IMPROVEMENTS AND SERVICES <br /> �i Walter <br /> Service Provider r Annex-Formation Distance to Public <br /> Public Water O Required Water (Feet) <br /> Private Water Existing Well New Well ❑ Well Replacement ❑ <br /> Public Sewage ; Service Provider Annex-Formation Distance to Public <br /> Disposal O l Required Sewer Facility <br /> r <br /> On-site Sewa a Existing Septic System New Septic System O Other ❑ <br /> Chspos11 <br /> StOttC1 Firill�e <br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention- <br /> Drainage❑ Required to: Retention Ponds <br /> Private Storm On-site Retention Pond(e) O Natural Drainage/No Change Other ❑ <br /> Drainage <br /> ': 3~Ilictil0�t: ! '. -' ; ,NItt11t1tI[3�ra <br /> Service Provider Distance to Service Servs-e Provider Distance to <br /> Service <br /> Telephone SMrvice ir.*hJN Television Service <br /> Service Provider Distance to Service Service Provider Distance to <br /> Service <br /> Sofioot Serttloir fire Pldteollon Setvice <br /> Service Provider (Distance to Elem Service Provider Distance to Fire <br /> School Station <br /> L. .S. CAI-' GC�ood r,' irc <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> 44 Yes❑ NoJK Yea❑ No <br /> � - Yes ❑ No Yes❑ No <br /> Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks <br /> rYes❑ No O Yes O No❑ <br /> Yes ❑ No 0 Yes 0 No 0 <br />