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APPLICATION- MINOR SUBDIVISION
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
<br /> Parcel Number Existing or Proposed Use of Parcel Square Footage
<br /> or Acreage
<br /> �O DSS Df�I� S1 O
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<br /> .. .... SerAoe Provider Public Water Annex-Formation Distance to Public
<br /> Existing❑ Required Water(Feet)
<br /> Proposed❑
<br /> Private Wader Existing Wall 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-este Sewage Existing Septic System ❑ New Septic System Other ❑
<br /> DisposalA
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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 Onitte Retention Pond(s) ❑ Natural Dralnage/No Change Other ❑
<br /> Drainage❑
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<br /> Service Provider Distance to Service Service Provider Distance to
<br /> Service
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<br /> Service Provider Distanoe to Servk0e
<br /> Service provider Distance to
<br /> Service
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<br /> Service Provider Diatanoe to Eiem 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 Yes O No bY
<br /> Ta 1,1q z Q Yes❑ No Yes❑ No
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> Yes❑ No❑ Yes❑ No❑
<br /> Yee❑ No❑ Yes❑ No❑
<br /> -3-
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