Laserfiche WebLink
• �:,PS1iJflV""• <br /> ` t.� SAN >� A Q U I N Environmental Health Department <br /> �f --- C O U N T Y-___._ <br /> Greatness grows here. <br /> New Well Information <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption <br /> criteria must submit the following required information, to the extent that can be reasonably known. <br /> The Environmental Health Department must collect this information before a new well permit is <br /> issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFOR <br /> Well Location Address: 7 2n City: <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Nam • Applicant Title: <br /> Applicant Address: City: <br /> Applicant Phone: _ Applicant email: <br /> Property Owner Name: / <br /> Property Owner Address: t- Qa City: <br /> Property <br /> �Owner Phone: — Property Owner email: <br /> Well Total Depth(ft): Acres to be Served by Well: f <br /> Use of Well: ❑ Domestic 4 Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): ¢j Ac <br /> Proposed Well Capacity(gal/ft): t{p 0 Estimated Pumping Rate(gal/min): Yp v <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): (o <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: ❑ Domestic (Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Total Depth(ft): To: .from: <br /> Casing Diameter(in): 13 Open Bottom or Screen Interval(ft): To: V V, From: <br /> Pumping Rate(gpm): r ,l<"- To: U From: <br /> Annual Extraction Volume(acre-feet: /, ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): �r <br /> Other Pumping Tests Performed: /, Test Result: <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 vwvw.sjcehd.com <br />