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y n. APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PILE NUMBER. <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposed Use of Parcel Footage or Acreage Footage or Acreage <br /> IC:CZ n7x AZ r 1 Z_ 4,— Z ,O f <br /> 2 c F4 Dems I . 3 4G <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation <br /> Public Water Service Provider Distance to Public <br /> Re aired Water Feet <br /> Proposed El – - <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 /> Existing <br /> On-site See <br /> Dis sal Existing Septic S stem New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ R uired to. Ponds <br /> Existing❑ <br /> PrivateSto <br /> Drama e On-site Retention Ponds _1 Natural Drainage/No Chane Other <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> PG E n-.3 e <br /> School Ser-Ace Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> odr e "'A71 <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> U er <br /> /,,of Yes❑ NoX Yes❑ No <br /> 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 /> P:0EvsvclPlannirg Apprce6on Forms) Page 4 of 7 <br /> Lot Line Adiistment.0m.(Revised 05-11-09) <br />