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to 210009 3 <br />SAN J O A Q U I N Environmental Health Department <br />COUNTY <br />Water Usage Information <br />PROJECT INFORMATION <br />Application Number: Application Type: <br />Project Address: 'j T'7? = 1 i r-9 `Z. _ Project APN: .2-}5U <br />Applicant Name: C L ,;Z7w,i 25 Title: <br />Applicant Address: •z-7 i t 1 ST. Cit ylZi t-2. c---/ 1W I <br />Applicant Phone: y 1 " -;70 i 5GEmail: 'e)So cp—JEi i GM <br />Property Owner Name: <br />Property Owner Address: Cit /Zip: <br />Property Owner Phone: Email: <br />SERVICES INFORMATION <br />Please provide description below: <br />Water Supply: Surface Water Attach Water Rights Informationvu..s o% i K is o Qry g <br />Domestic Wastewater Disposal: r c -t- ry yL <br />Process Wastewater Discharge: Ponds:7 A licable WDR: <br />Storm Drainage System: Vies. n lz; 0,i7Ti <br />WATER USAGE DATA <br />Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br />Domestic Water Usage by Employees/Customers: 1 , 6 2 3 <br />Type of Process/Irrigated Lands Total Gallons/Da <br />Process Water Usage: G <br />Process Water Usage: <br />Irrigation Water Usage: cti Lkz3 z E, <br />Total Gallons Per Day: <br />PROPOSED WELL LOCATION 70/A- <br />Well Location Address: I Cit <br />Well Location APN: <br />Well Latitude:1 Well Lon itude: <br />Flood Plain Desi nation: Well Elevation: <br />PROPOSED WELL INFORMATION <br />Well Total De th(ft): Acres to be Served b Well: <br />Use of Well: <br />Domestic El Irrigation Small Public Water Supply El Municipal Public Water Supply El Industrial El Stock <br />Other: <br />Depth of Corcoran Clay(ft): <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 />SITING INFORMATION <br />Distance To Nearest(ft): Onsite: Offsite: Distance To <br />NnWaterway: <br />Onsite: Offsite: <br />Wastewater Treatment S stem: Sources of C <br />Other Wells: <br />Sewer Lines: r: <br />Animal or Fowl Enclosure: Navigab <br />Storm Draina e S stem: Potential Rechas: <br />GROUNDWATER INFORMATION <br />Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br />Current Depth to Water: C,) , C)Vd r- ILt <br />1); Coa S?fy u i o ElCosumnes Subbasin(2-22.16) <br />Highest Depth to Water: C'C) r_ Eastern San Joaquin Subbasin(5-22.01) <br />Lowest Depth to Water: 70 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.sjcehd.com <br />1 of 2