Laserfiche WebLink
'0' SA NUJ OAQ U I N Environmental Health Department <br /> l" <br /> —COUNTY <br /> — <br /> ILL I FOP� Greatness groves here. <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: Z7 City: AyVjprdj;2pk,'XF <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: S -4geApplicant Title: N�12 <br /> Applicant Address: 1Z4� L_G� /> City: <br /> Applicant Phone: �' Zf Applicant email: , <br /> S -4-77 Owner Name: <br /> Property Owner Address: �. _ 35-3' City: RIA l <br /> Property Owner Phone: vq 5•—� d Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Z Acres to be Served by Well: Ze 7 <br /> Use of Well: ❑ Domestic Irrigation El Small Public Water Supply El Municipal Public Water Supply El Industrial El Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <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 ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ 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 />