Laserfiche WebLink
SAN 10 A Q U I N Environmental Health Department <br /> ---COU NTY— <br /> c� P Greatness crows 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: Sc1 �' vl P.D- City: Lod, <br /> Well Location APN: gc)- <br /> GJ <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: e �`� h Applicant Title: c l\ <br /> Applicant Address: c . p a City: �G <br /> Applicant Phone: 3Q9 _ �2 7 7 Applicant email: VGA a `���'�r SbC� ►a bu\ .he-} <br /> Property Owner Name: \,` ',C z <br /> Property Owner Address: 5 1 { t�A- Q d, City: Lod <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well:1 12 S <br /> Use ofWell: ❑ Domestic El Irrigation El Small Public Water Supply ❑ Municipal Public Water Supply Industrial El Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): ,^ Estimated Pumping Rate(gal/min): 'a PM <br /> Anticipated Pumping Schedule(gal/day): ujelj I Estimated Annual Extraction Volume(acre-feet): 0 � <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 Wel?ED <br /> �Domestic ❑ Irrigation ❑ Small Public Water Supply ElMunicipal Public Water Supply ❑ Industrial El Stock <br /> Other: <br /> Total Depth(ft): a7S To: 0115 From: 075 <br /> Casing Diameter(in): (p •❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): '�5 To: From: <br /> Annual Extraction Volume(acre-feet: .o7G 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 />