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<br /> APPLICATION R _OT LINE ADJUSTMENT
<br /> SAN JOAQUIN COUNTY )MMUNITY DEVELOPMENT DEPARTMENT
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<br /> Parcel Number Existing or Proposed Use of Parcel
<br /> Existing Proposed
<br /> Square Footage Square Footage
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<br /> Service Provider
<br /> Public Water❑ Annex-Formation DistancetoPublic
<br /> Required Water(Feet)
<br /> Private Water■ Existing Well ■ New Well ❑
<br /> Well Replacement ❑
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<br /> Public Sewage Service Provider
<br /> Disposal❑ Annex•Formation Distance to Public
<br /> Required q Sewer Facility
<br /> On-site Sewage Existing Septic System ■ New Septic System ❑ Other ❑
<br /> Disposal■
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<br /> Drainage❑ uired to:
<br /> Retention Ponds
<br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change ■ Other ❑
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<br /> Service Provider Distance to Service Service Provider
<br /> Distance to
<br /> Service
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<br /> Distance to
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<br /> Service Provider Distance to Elem Service Provider
<br /> School Distance to Fire
<br /> Station
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter
<br /> Sidewalks
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<br /> Sidewalks
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