Laserfiche WebLink
SAN 10AQUIN Environmental Health Department <br /> COUNTY----- <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: z — City: <br /> Well Location APN: —v 3 <br /> Well Latitude: 9 7 3 Well Longitude: J'),Cu t 7_;;,vv <br /> Flood Plain Designation: Well Elevation: vZ/ <br /> Applicant Name: ; Applicant Title: . <br /> Applicant Address: �'�;, jd,'✓ca< ( ;' City:WOG <br /> Applicant Phone: — _ V72-5- <br /> 7S Applicant email: <br /> Property Owner Name: 6 LV 640 f LLG <br /> Property Owner Address: d' oCj P=R City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):l I Acres to be Served by Well: <br /> Use of Well: ❑ Domestic rigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 9,ew Estimated Pumping Rate(gal/min): PVv <br /> Anticipated Pumping Schedule(gal/day): /L_ ���� Estimated Annual Extraction Volume(acre-feet): /U L <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> i <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: <br /> ❑ Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): r ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 12c,' To: From: <br /> Annual Extraction Volume(acre-feet: /4�1�1 21 Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): , k ,,,.r, <br /> Other Pumping Tests Performed: "--- I 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 />