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a:JJ!ir <br /> SAN ,,, OAQ U I N Environmental Health Department <br /> {' - COUNTY <br /> Greotness 5r-ows 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 LOCATIONINFORMATION <br /> Well Location Address: �, ° , d City: ;� A <br /> Well Location APN: _ x: r <br /> Well Latitude: `" L�� Z ��n Well Longitude: /z� u ► G �~-' <br /> Flood Plain Designation: Well Elevation: 117a <br /> Applicant Name: Canepa and Sons,Inc. Applicant Title: Contractor <br /> Applicant Address: 14384 Cuesta Court City: Sonora <br /> Applicant Phone: (209)532-1136 Applicant email: csonsdrilling@gmail.com <br /> Property Owner Name P/7 'fi ' lr el e d" <br /> Property Owner Address: z,` ' 1 City: <br /> Property Owner Phone: Property Owner email: <br /> PROP�OSEQapIIELL I�V�ORI�q'TION'=s�`` _ � �"` = �� -;�_�t' �� y', 1� � •,���� ��=� ��, <br /> Well Total Depth(ft):1 1Acres to be Served by Well: <br /> Us7offtl: ElDomestic �16 Irrigation ❑Small Public Water Supply 1:1Municipal Public Water Supply ❑ Industrial ❑Stock <br /> Us <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): , 6A&' <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): , <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> :EXISTING WALLS INFORMATION L' <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 />