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oc, !l��T /fit fta A ,�. <br /> °P � oSAN 10AQUIN Environmente <br /> " —COUNTY— ry �2 UAY W <br /> c.aP' Greatness grows here `� ,'V <br /> Well Exemption Statemen— /" <br /> Pursuant to California Water Code, Section 13808, all new wells that do not me -S a.A <br /> additional information prior to the issuance of a permit by the Environmental H /���-- 25- til <br /> completed to document the exemption criteria applicable for the new well applica <br /> &7- <br /> 70 0 <br /> WELL LOCATION AND OWNER INFORMATION �— C'1W <br /> Well Location Address: 11707 N. Alpine Rd. — XA"lo <br /> Well Location APN: 061-160-31 <br /> — I <br /> Applicant Name: Hennings Bros. Drilling Co., Inc. Apl Avo <br /> Applicant Address: 1930 Ladd Rd. �L& <br /> Applicant Phone: 209-545-1185 App ILL- <br /> Property <br /> LCProperty Owner Name: Maria Pallavicini c/o Ron Veira <br /> Property Owner Address: 11707 North Alpine Rd. __- <br /> Property Owner Phone: 985-6400 Property C <br /> 117- /21- S O <br /> EXEMPTION CRITERIA <br /> Well meets any of the following Exemptions: <br /> ❑ Well not located in a critically overdrafted basin. ❑ Tracy Subbasin (5-22.15) ❑ Cosumnes Subbasin (5-22.16) <br /> ❑ New well owner will be a de minimis extractor: maximum two acre-feet(651,702 gallons)or less per year being <br /> extracted for domestic purposes only. <br /> EK Replacement well with same extraction as the existing well that it is replacing. To meet this exemption the existing <br /> well must be destroyed under permit or continue to be used for domestic purposes with total domestic extractions <br /> remaining two acre-feet or less per year. <br /> Purpose/use of existing well: K] Serve an existing residence ❑ Irrigate residential landscape <br /> New well estimated annual extraction volume: 650,000 <br /> Existing well estimated annual extraction volume: 0 <br /> Total Annual Domestic Use Volume: 650.000 <br /> ❑ Public agency that substantially meets or exceeds these requirements through another requirement of the law. In <br /> order to be exempt, the applicant shall document the laws that substantially meet or exceed these requirements <br /> and how the requirements of those laws were met. <br /> ❑ A city or county municipal well to provide water supply solely for residents of the city or county. <br /> I hereby certify that the information I have provided in this statement is accurate and truthful. <br /> Si ned: �` S� Date: September 28, 2018 <br /> Statement completed by: R Well Driller ❑ Well/Property Owner ❑ Other: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />