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APPLICATION - LOT LINE ADJUSTMENT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: PROPOSED PARCELS Parcel Number Existing or Proposed Use of Parcel Existing Square Footage or Acreage Proposed Square Footage or Acreage O 7 - l S,D - (DI < ao7-/loo -o? SITE IMPROVEMENTS AND SERVICES Water Public Water Service Provider Annex -Formation Re uired Distance to Public Water Feet Proposed ❑ Existin O� _ S r �— Private Water ❑ Existing Well New Well ❑ Well Replacement ❑ Sewage Disposal Public Sewage Disposal Service Provider Annex -Formation Re uired Distance to Public Sewer Facility Proposed ❑ Existin ❑ (rLJ�> 5�-� On-site Sewage Disposal ❑ Existing Septic System ❑ New Septic System ❑ Other ❑ Storm Drainage Public Storm Drainage Proposed ❑ Service Provider (if Public) Annex -Formation Required Terminal Drainage to: Detention -Retention Ponds Existing ❑ Private Storm Drainage ❑ On-site Retention Ponds ❑ Natural Drainage/No Chane Other ❑ Electricity Telephone Service Service Provider Distance to Service Service Provider Distance to Service School Service Fire Protection Service Service Provider Distance to Elem School Service Provider Distance to Fire Station Existing Roads Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks p ' L/ Yes ❑ No45. Yes ❑ No 2, Yes ❑ No ❑ Yes ❑ No ❑ Proposed Roads Road/Street Name R.O.W. Width Pavement Width Curb/Gutter Sidewalks Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ F.IDEVSVC\Planning Application Forms\ Page 4 of 7 Lot Line Adjustment.doc. (Revised 05-11-09)