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❑ SERVICES <br /> List the public services and facilities which will be necessary for <br /> the project . Specify what public agency, if any, that will provide <br /> each . If private or individual services are proposed, explain: <br /> Are services cur- <br /> rently provided? Which City, Special District , <br /> If no, how far will etc . , will be providing each <br /> lines need to be service or what private <br /> Service extended? services are proposed? <br /> Water _Yes :i_No 2000 ft. ± on-site wQ11 <br /> Sewer _Yes X_Noa/A :peptic tank and leach field _ <br /> Drainage _Yes IL No30QO ft. + +n nomain as: azisting, — <br /> Electricity X_Yes No P.G.&E. _ <br /> Gas X Yes No P.G.&E. _ <br /> Yes —No— <br /> Proposed <br /> oProposed property size and use : <br /> Parcel 1 size: 26,991 S.F. ��, 6��� use : Residential <br /> Parcel 2 size: 32,39_ o, 7yy c, use :—Residential <br /> Parcel 3 size: use : _ <br /> Parcel 4 size: use : _ <br /> ❑ SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> ❑ Legal Owner (s )-(All owners must sign as their names appear on the <br /> deed. ) , <br /> Corporate Officer ( s ) empowered to sign for the corporation, <br /> LlOwner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and that the foregoing is true and correct . <br /> (Signatur ) �, (Date ) <br /> C�A;e�_Z <br /> "ot Line Adjustment - 4 - ( 8/86 ) <br />