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COUNTY---__.. <br /> Greatness groiw—. here, <br /> Water Usage Information pA 1800145 <br /> PROJECT.INFORMATION;; <br /> Application Number: Application Type: <br /> Project Address: :�4 S-1 V L, e 'eA•t Qj Project APN: <br /> Applicant Name: Title: <br /> Applicant Address: 5ZJO g cq t-q a City/Zip: "33 <br /> � Applicant Phone: C Email: <br /> Property Owner Name: <br /> Property Owner Address: c, City/Zip: - v � <br /> Property Owner Phone: S-CF S-' Email: <br /> SERVICES..INFORMATION. <br /> Please provide description below: <br /> Water Supply: Z�` ❑ Surface Water(Attach Wafer Rights Information) <br /> Domestic Wastewater Disposal: <br /> Process Wastewater Discharge: Ponds: Applicable WDR: <br /> Storm Drainage System: <br /> WATER-USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day Gallons/Persoh/Da . TbtalGallons/Day. <br /> Domestic Water Usage by Employees/Customers: <br /> T, of Proc�ss`rir igated Lands Total G�Ilons7Day J. <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total 6alions Per Day;; <br /> PROPOSED WELL LOCATION. <br /> 1 <br /> Well Location Address: I Ci :- <br /> Well Location APN. <br /> Well Latitude: Well Longitude:1 <br /> Flood Plain Designation: Well,Elevation: <br /> PROPOSED WELL INFRMATION <br /> Well Total De th(ft):1 Acres to be Served by Well: <br /> Use of Well; ❑ Domestic ❑ Irrigation LlSmall Public Water Supply ElMunicipal Public Water Supply ElIndustrial ElStock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min j J-- <br /> Antici ated Pumping Schedule (gal/day): Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> SITING INFORMATION <br /> -Distance To Nearest ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure: Navigable Waterway:l I <br /> Storm Drainage System: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: I ❑ Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: I ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.smcehd.com, <br /> 1 of 2 <br />