Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br /> -----COUNTY-----. <br /> Greatness grows 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: � j L� City: <br /> Well Location APN: 0 , <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: ������/� .— Applicant Title: <br /> Applicant Address: 1,?© ' City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: t— <br /> f�U <br /> Property Owner Address: SGS GS 0x:—City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I 01V _ Acres to be Served by Well:1 3, <br /> Use of Well: Domestic girrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): p <br /> Anticipated Pumping Schedule(gal/day): j; Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): `y <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 S <br /> Use of Well:IvDomestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): , d SiTo: From: <br /> Casing Diameter(in): " ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 676 To: From: <br /> Annual Extraction Volume(acre-feet: y 0 Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): $r <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />