Laserfiche WebLink
SAN J O A Q U I N Environmental Health Department <br /> COUNTY— <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 INFORMATION <br /> Well Location Address: <br /> Well Location APN: <br /> Well Latitude: j2' S.qB" Well Longitude: °2' X sG' <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: '11e, f- Applicant Title: <br /> Applicant Address: n�r <br /> I CC-5/ 6-2;x4/100 3e. /o Aa 24 City: <br /> Applicant Phone: <br /> A-1 q-&pS_3 RIF Applicant email: <br /> n�k e ahao. <br /> Property Owner Name: SAme� <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I 34jl Acres to be Served by Well: <br /> Use of Well: ❑Domestic li$Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): 1:7cu- <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): /'j Q <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 3�� <br /> Estimated Cumul tive Extraction Volume before January 1,2020(acre-feet): 5 <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 El Small Public Water Supply El Municipal Public Water Supply 13 Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): O To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): a- To: From: <br /> Annual Extraction Volume(acre-feet: IR Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <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 www.sjcehd.com <br />