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4` 2PP'LICATION - LOT LII\ ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I <br /> FILE NUMBER: <br /> •a <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number ExistJnq or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> o e- <br /> S <br /> ` SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Pu6fic Water Service Provider Required Water Feet <br /> Praposed�,J QGl' LI/�/ <br /> UZIWAI <br /> Existin �d`'I <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 Q <br /> Existin —ZTe /" Vl C E' <br /> On-site Sewa e <br /> r Dis osal Existing Septic System ❑ New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(it Public) Annex-Formation Terminai Drainage Detention-Retention <br /> Proposed C1Required to: Ponds <br /> Existing `j. Oc✓ OV <br /> Private Storm <br /> Draina a C3 I On-site Retention Ponds Natural Drainage/No Chane 0 Over ❑ <br /> ElecWclty Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to.Service <br /> Si <br /> Sc ool Service Fire Protection Service <br /> Distance to Elem <br /> i' Service Provider, School Service Provider Distance to Fire Station <br /> J'IJ /-v. <br /> ' <br /> Existing Roads <br /> } Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> O G f Yes❑ No Yes❑ No <br /> s J Yes❑ NoW Yes❑ No2!� <br /> Proposed Roads <br /> RoadIStreet Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes ❑ No ❑ <br /> Yes❑` No❑ Yes ❑ No ❑ <br /> F:0EVSVCtP1ar"ng Ap*aOon F«ms1 Page 4 of 7 <br /> Lot One AdjusvnenL.doc.lRevisad 6.4.04) <br /> 1 <br /> 4 <br />