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SAN .,JOAQUIN Environmental Hft&Cfta,ftment <br /> —COUNTY— <br /> ;; ; ,`Y Greotness grows here. MAR I9 2019 <br /> Water Usage Information ENVIRONMENTAL HEALTH <br /> PROJECT INFORMATION PERMIT/SERVICES <br /> lication Number. p _ o Z3 Application 7 e: s <br /> Pro'ect Address: Soo N , A c��oa .� Pro'ect APN: z <br /> A Iianf Name: D tom.) TZ a <br /> A licantAddress: gp yo o� Titie: <br /> Ci Zip; <br /> A lit ant Phone: i N <br /> Z a Z l - o z 6 Email: sTCznr ro <br /> Properiv Owner Name: W�. <br /> Property Owner Address; y <br /> S oo tJ FacCc-c Ci lzl : 5ro' <br /> Property Owner Phone: -o S�( G_ O Z6 A i S'- <br /> SERVICES INFORMATION <br /> Please rovide descd tion below: <br /> Water Supply: ` <br /> ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Dis osal: i <br /> Process Wastewater Dischar e: Ponds; A pliable WDR: - m <br /> Storm Drainage S stem: -0 <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons <br /> /Day <br /> Domestic Water Usage b Em to eeslCustomers; /00ot3o <br /> T e of Process/Im ated Lands a <br /> tat Gallons/D <br /> Process Water Use e: Ga l w <br /> Process Water Usage: <br /> ra <br /> Im ation'Water Use e: <br /> Total Gallons Per Day: CU pp <br /> PROPOSED WELL LOCATION 4 <br /> Well Loca fl Address: Cit <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Des' nation: Well Elevatlon: <br /> PROPOSED WELL INFORMATION <br /> Well Total De th (ft):: Acres to be Served b Welt: <br /> Use of Well: 11 Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft <br /> Proposed Well Ca abity al.. : Estimated Pumpin Rate aVmin <br /> Anticipated Pumpin Schedule gal/da Estimated Annual-Extracuon Volume(acre-feet)j <br /> SITING INFORMATION Estimated Cumulative Extraction Volume before Janua 1,2020 acre-feet): <br /> Distance ToNearest ft: Onsfte: Offsite: Distance To Nearest ft): Onsite: Offsite: <br /> Wastewater Treatment S stem: Sources of Contamination: <br /> Other Wells: Pond/Lake; <br /> Sewer Lines: Stream/River. <br /> Animal or Fowl Enclosure: Navi able Waterway: <br /> Storm Drainage S stem: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): SourcelDate of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑��Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: W'Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water. ❑Tracy Subbasln(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www-sicehd.com <br /> 1 oft <br />