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APPLICATION- MINOR SUBDIVISION
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Parcel Number Exkdng or Proposed Use of Parcel Square Footage
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<br /> Public Water Service Provider Annex-Formation Distance to Public
<br /> Existing a Required Water(Feet)
<br /> Proposed❑
<br /> Private Water lee Existing Well )8f New Well ❑ Well Replacement ❑
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<br /> Public Sewage Service Provider Annex-Formation Distance to Public
<br /> Disposal Required Sewer Facility
<br /> Existing❑
<br /> Proposed❑
<br /> On-site Sewage Existing Septic System New Septic System ❑ Other ❑
<br /> Disposal Ili
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<br /> Public Storm Service Provider Annex-Formation Terminal Drainage Detention-
<br /> Drainage Required to: Retention Ponds
<br /> Existing*
<br /> Proposed❑
<br /> Private Storm Onsite Retention Ponds) ❑ Natural Dralnage/No Change Other L1Drainagrt
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<br /> Service Provider Distance to Elem Service Provider Distance to Fire
<br /> School Station
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> �} Yes❑ No q Yes❑ Nox
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<br /> -3-
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