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WP0038879
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4200/4300 - Liquid Waste/Water Well Permits
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WP0038879
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Last modified
8/1/2019 1:37:35 PM
Creation date
8/1/2019 11:44:52 AM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0038879
PE
4380
STREET_NUMBER
4656
Direction
E
STREET_NAME
GARIBALDI
STREET_TYPE
AVE
City
STOCKTON
Zip
95215-
APN
08708015
ENTERED_DATE
10/10/2018 12:00:00 AM
SITE_LOCATION
4656 E GARIBALDI AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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'.l <br /> ,QUIIN <br /> T� ;, SAN JOAQUIN Environmental Health Department <br /> L < --COU N T Y----- <br /> Greatness grows here:. <br /> Well Exemption Statement <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit <br /> additional information prior to the issuance of a permit by the Environmental Health Department. This form must be <br /> completed to document the exemption criteria applicable for the new well application. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: i I City: <br /> Well Location APN: <br /> Applicant Name: /l�Cl'�G Applicant Title: — x�• - <br /> Applicant Address: I City: <br /> Applicant Phone: 2a,�r -77Z -z 7S-7 Applicant email:Z,&&,, <br /> Property Owner Name: jA <br /> Property Owner Address: y s ,n / ���/,' AvE_ City: �-��� jdN �°a �3`�z ih <br /> Property Owner Phone: 2O c~_ Property Owner email: <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 /> rextracted for domestic purposes only. <br /> 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: ❑ Serve an existing residence P Irrigate residential landscape <br /> New well estimated annual extraction volume: <br /> Existing well estimated annual extraction volume: /e2 <br /> Total Annual Domestic Use Volume: ,:;, ?, g°o <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 th info ation I have proviO4 in this statement is accurate and truthful. <br /> Signed: 2 Date: /O <br /> Statement completeWell Driller ❑ Well/Property Owner ❑ Other: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />
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