Laserfiche WebLink
.-rff-, SAN 10AQUIN Environmental Health Department <br /> " Li.kt_�;` `' -----COU NTY- - <br /> oq`4. - r> 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: -)S J,) I City: 6(Well Location APN: 0.),3 (LYL9 <br /> Well Latitude: v ' Well Longitude: -/�/O 33 v <br /> Flood Plain Designation: Well Elevation: 1-74 Z <br /> Applicant Name: Ke bt 1Applicant/Title: /If <br /> �- <br /> Applicant Address: U h City: w,x�c �; ,l <br /> Applicant Phone: 3 �-7_ Appli ant email: <br /> Property Owner Name: /71; "Ter, <br /> Property Owner Address: e j,,, City: <br /> Property Owner Phone: (w S - -3 Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): QQ Acres to be Served by Well: <br /> & Crc�Use of Well: ❑ Domestic Irrigation ❑ 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): �x <br /> FAnticipated Pumping Schedule(gal/day): /�ILj C'�'c% / Estimated Annual Extraction Volume(acre-feet): <br /> Estimated mulative 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 ElMunicipal Public Water Supply ElIndustrial ElStock <br /> ❑ Other: <br /> Total Depth(ft): 350 To: From: <br /> Casing Diameter(in): 19'6pen Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): W To: From: <br /> Annual Extraction Volum (acre-feet: B-'Estimated ❑ Measured <br /> Specific Capa ty(gal/min/ft): ]�9,4 <br /> Other Pumping ests 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 />