Laserfiche WebLink
SAN JOAQU[N <br /> Environmental Health Department <br /> L <br /> COUNTY-- <br /> :s;.) Creotness 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 OCATION'p1ND 0111fNER IIVFOR(VI21TloN.._... ' ;xIN J <br /> Well Location Address: t7, City. <br /> Well Location APN: _Z _ <br /> Well Latitude: e (P'32 z rr Well Longitude: 2 <br /> Flood Plain Designation: --4Weil Elevation: <br /> Applicant Name: 5 Applicant Title: <br /> Applicant Address: City: Y� <br /> Applicant Phone: rte' z_ Applicant email:1�400.5 f L401`Yl <br /> Property Owner Name: E/ <br /> Property Owner Address; Qif� City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSEDWELLINFORMATIONr��"..�. h '.����t;:."� <br /> � � , <br /> Well Total Depth(ft): '_ Acres to be Served by Well:5 <br /> Use of Well: ❑Domestic )(Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): (y <br /> Proposed Well Capacity(gallfl}: Estimated Pumping Rate(gal/min): g <br /> Anticipated Pumping Schedule(gallday): Estimated Annual Extraction Volume(acre-feet): '1-1 <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EASTING-WELLS_INFOf2MATIQN. s`r n t AN :�, t �Y <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 O industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gallminlft): <br /> Other Pumping Tests Performed:1 Test Result: <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />