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SHAMAN . <br /> Environment,- Health Department <br /> COUNTY <br /> Greatness here. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Ap lication Number: Application Type: af-Ajr1& IAL- <br /> Project Address: &6S() Lboi Q, Project APN: <br /> Applicant Name: <br /> Title: 4&&WJ�L 6-j( K_ _Q <br /> Applicant Address: p, ftpy, (ott City/Zip: <br /> Applicant Phone:1 7toJ '�",L4 Email: MI Ner <br /> Property Owner Name: <br /> Property Owner Address: T' v 13v>c zt4 6 1 City/Zip:l V)fL-NVkr 2vvc lq�� qD <br /> Property Owner Phone: -2-ol 1 Email: Ot(e at VA'4 M&,�-I vr,, <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: 11 Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: S iC S�4S-rf�14 I pplicable WDR--.-F— <br /> Process Wastewater Discharge: Ponds: I A <br /> Storm Drainage System: f <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day Gallons/Person/Day Total Gallons/Day <br /> Domestic Water Usage by Employees/Customers: ID ;~t,5 tt)-, ' -. 4% <br /> Type of Process/irrigated Lands Total Gallons/Day <br /> Process Water Usage: 7-42-V %-r- 'VV X'S") NG7 <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Day: <br /> WELL LOCATION <br /> Well Location Address: &5to WT-th- Cityl WD( <br /> Well Location APN: <br /> Well Latitude: 3?)" C9 ls"g Well Longitude:1 <br /> Flood Plain Designation: 7_� Well Elevation:1 FT- <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I Acres to be Served by Well:1 <br /> Use of Well:-ADomestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply El Industrial 0 Stock. <br /> El 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 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.1 <br /> Storm Drainage System] Potential Recharge Features] <br /> GROUNDWATER INFORMATION <br /> De th ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: El Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: 0 Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: El 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 Arvvw.sjcehd.corn <br /> 1 of 2 <br />