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PPLICATION - LOT LI" ADJUSTMENT <br /> _ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE 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 /> r <br /> .l . SAcre.S r';' , -1+ Acw <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Propos ad® - <br /> Existin ❑ (t. I Lv •1 c (' NL C,' 1'{ <br /> Private Water❑ Existing Well ❑ New Well ❑ Well Re lacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed ❑ <br /> Existin ❑ <br /> On-site Sewage _ <br /> Dis sal❑ 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 /> Draina e❑ On-site Retention Ponds ❑ Natural Draina a/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Service Provider Distance to Fire Station <br /> sTl-knl � l _ d, CC �f, T- <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> LA_ I i Lr` Yes❑ No[g Yes❑ No C <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> /j ` Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> FMEVSMIPlanning Application Fonm1 Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />