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APPLICATION - LOT LINT ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ds I <br /> �'�'• FILE NUMBER: <br /> � j <br /> PROPOSED PARCELS <br /> Existing Square Proposed Square <br /> Parcel Number Existing or Proposeo ProposeUse of Parcel Footage or Acreage Footage or Acreage <br /> 2 rd oss� e 2 - ¢ Z , <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Annex-Formation Distance to Public <br /> Public Water Service Provider Required Water Feet <br /> Proposed❑ <br /> Existing ❑ <br /> Private Water Existing Well New Well Well Re lacement <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Re uired Sewer Facility <br /> Proposed ❑ <br /> Existing❑ <br /> On-site Sea e <br /> Dis osal Existing Se tic S stem New Se tic System Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed ❑ Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Draina e ❑ I On-site Retention Ponds Natural Drainage/No Chane Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> School Service Fire Protection Service <br /> Service Prov i Mer Distance to Elem School Service rovlder Distance to Fire Station <br /> Existing Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> �v 2 Yes❑ No Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Yes❑ No❑ Yes❑ No❑ <br /> Yes❑ No❑ Yes❑ No❑ <br /> F:\DEVSVC\Planning Application Forms\ Page 4 of 7 <br /> Lot Line Adiustment.doc.(Revised 6-4-04) <br />