Laserfiche WebLink
S Q N Q A Q Q N Environmental Health Department <br /> Ok <br /> t - �; <br /> _.._COUNTY --- <br /> • , �' `, reatness 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: �-73 5 City: ;,t <br /> Well Location APN: <br /> Well Latitude: 69 L Well Longitude: — -I&I, <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: '.11 , 1 ko,"• Applicant Title: f <br /> Applicant Address: -, , t 7 "? t City: <br /> Applicant Phone: ,� d _ 6 C,%7,;� Applicant email: <br /> Property Owner Name: &J Vi 5. (�C <br /> Property Owner Address: 9" � -) c 11 <br /> Property Owner Phone: 91Y-- -3 S ,z a– Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 0 1; Acres to be Served by Well: --a, <br /> Use <br /> C <br /> Use of Well: ❑ Domestic Xrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): OG7 f--I Estimated Pumping Rate(gal/min): � ',e <br /> Anticipated Pumping Schedule(gal/day): yyZ Estimated Annual Extraction Volume(acre-feet): /06, <br /> Estimated umulative 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 />