Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> _„ .. . 1N3AINdd34 <br /> H11VaM 1y1N8wNo�lr,n:3 <br /> Water Usage Information slot 9l afFll <br /> PROJECT INFORMATION <br /> Application Number: Q es Application Type: s k <br /> Project Address: Soo 0 , q-4z% ProjectAPN: t o — o O - L <br /> Applicant Name: bNj % 0 Tifle: <br /> Applicant Address: $CA u Q E=o City/Zip: <br /> Applicant Phone: Z a Ck Si�2 r <br /> Property Owner Name: Vi\o o C2,a o u c '� <br /> PropertyOwner Address: 5 0o 0 , cCc-c MIA ti Le-Y I Clityalpl cp,, 19 L� <br /> Property Owner Phone: "io S Com- Email: <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: VJA ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: I %-:L— <br /> Process Wastewater Disohar e: Ponds: Applicable WDR: <br /> S - Cp <br /> Storm Drainage stem: -p <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/PersonlDa Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: _66, 15 �?+( �} �soa A✓ <br /> _ T of Process/Irrigated Lands Total Gallons/Da <br /> a Process Water Usa e: t?rcGLL,e Pc,� )7qy 2 <br /> Process Water Usage: r k1l¢7" c CO <br /> Irrigation Water Usage: <br /> Total Gallons Per Da : j'7 Y7 <br /> PROPOSED WELL LOCATION ,I- <br /> Well Location Address: I City: <br /> Well Location APN: <br /> Well Latitude: Well Lon itude: <br /> Flood Plain Desi nation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth Rd I Acres to be Served by Well: <br /> Use of Well: 0 Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Cie ft <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate aVmin : <br /> Anticipated Pum in Schedule allda : Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative Extraction Volume before Janua 1,2020 acre-feet <br /> SITING INFORMATION <br /> Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): I Onsite: I Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: SVeam/River. <br /> Animal or Fowl Enclosure: I Navigable Waterway: <br /> Storm Drainage System: I Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑C sumnes Subbasin(2-22.16) <br /> Highest Depth to Water: Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> 1 of 2 <br />