WP0040722 - Laserfiche WebLink

Home Browse Search

S A N ,J O A Q U IN Environmental Health Department COUNTY-- - - New Well Information Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit the following required information, to the extent that can be reasonably known. The Environmental Health Department must collect this information before a new well permit is issued and must post the information on the Department's website for public information. WELL LOCATION AND OWNER INFORMATION Well Location Address: City: Well Location APN: _ 1 Well Latitude: 001,417— Well Longitude'-=2.1- Flood Plain Designation: Well Elevation: Applicant Name: 11mil Am Applicant Title: Applicant Address: City: Applicant Phone: ILZOA5 Applicant email: Property Owner Name: Property Owner Address: F City: Property Owner Phone: Property Owner email: PROPOSEDJNELL INFORMATION Well Total Depth(ft): I Acres to be Served by Well: Use of Well: ❑Domestic XIImgation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock ❑Other: Depth of Corcoran Clay(ft): %Alp, Proposed Well Capacity(gal/ft): 0 Estimated Pumping Rate(gal/min): UD Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): t5G Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): EXISTING WELLS INFORMATION Total Number of Existing Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Well#1 Information Use of Well: ❑Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply Cl Industrial ❑ Stock ❑Other: Total Depth(ft): To: From: Casing Diameter(in): NOpen Bottom or Screen Interval(ft): To: From: Pumping Rate(gpm): a0 To: From: Annual Extraction Volume(acre-feet: 41C Estimated ❑ Measured Specific Capacity(gal/min/ft): 00 1 Other Pumping Tests Performed: Test Result: 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com