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-IPLICATION — LOT Lid ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existinci or Pro osed Use of Parcel Foota a or Acreage Footage or Acreage <br /> � ro oSe <br /> 2.5 2 c._ <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed n <br /> Existin <br /> Private Waterlo I Existing Well 10 <br /> New Well Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal <br /> Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Exisincl❑ -- <br /> On-site Sewage <br /> Disposal <br /> Existinq Se tic System New Se tic S stem Other ❑ <br /> Stonn Drainage <br /> Public Storm Annex-Formation Terminal Drainage Detention-Retention <br /> Drainage Service Provider(i(Public) Required to: Ponds <br /> Proposed❑ <br /> Exisung❑ <br /> Private Storm Natural Drainage/No Chane Other ❑ <br /> Draina e❑ On-site Retention Ponds ❑ <br /> Telephone Service <br /> Electricity <br /> Distance to <br /> Service Provider service Service Provider Distance to ervice <br /> School Service Fire Protection Service <br /> Distance to Elem Service Provider Distance to Fire Station <br /> Service Provider School <br /> e s <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> / l C ) / —Z Yes❑ No Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> Pro osed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes ❑ No ❑ <br /> Yes❑ 'NG❑ Yes ❑ No ❑ <br /> F:0EV5VC\PianNng Application Forrns\ Page 4 of 7 <br /> Lu Line Adjusvnenl.doc.(Revised 6-4.04) <br />