Laserfiche WebLink
r <br /> SAN,J 0 A QU 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: G City: MXJCCU <br /> Well Location APN: 01211— '140 <br /> Well Latitude: ri C�j •(� r Well Longitude: .-12 . �9- 7 <br /> Flood Plain Designation: Well Elevation: 0 r <br /> Applicant Name: Applicant Title: <br /> Applicant Address: • 2- CO 0 City: M -0'I <br /> I <br /> ou <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: ' <br /> Property Owner Address: 21 Gu <br /> Property Owner Phone: J Property Owner email: <br /> PROPOSED,YVELL INFORMATION <br /> Well Total Depth(ft): ' Acres to be Served by Well: <br /> Use of Well: ❑ Domestic rrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): &OC) Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): e. , <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: Z <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(fVpp,,� <br /> To: From: <br /> Casing Diameter(in ,P Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpmTo: From: <br /> Annual Extraction Volume(acre-fe ,c 1714-,L) 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 />