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SAN JOAQUIN Environmental Health Department <br /> --,.—COUNTY------ <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: uj Project APN:_ <br /> Applicant N=2: Title: 0 <br /> Applicant Address: 5-,4*L4 4-v,4-o-,r Ci /zip: <br /> Applicant Phone: (lo ol-) Lt� -C(07--, Email: <br /> Property Owner Name: <br /> Property Owner Address: city/zip: <br /> Property Owner Phone: I Email:j <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: U-)1L 0 Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: ��??-'s e- 44 5'� "�- v- ro:?O'.�-P-"t <br /> Process Wastewater Discharge: Ponds: �Ap ricableWDR: <br /> Storm Drainage System: I <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: 11 100 1'.00 <br /> Type of Process/Irrigated Lands Total Gallons/Day <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> T Total Gallons Per Day: <br /> PROPOSED WELL LOCATION <br /> Well Location Address: Lo I City:1 <br /> Well Location APN: 6 0 — 3 14 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation:1 <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 P�CD 11 Acres to be Served by Well:1 <br /> Use of Well: `Domestic 0 Irrigation 0 Small Public Water Supply El Municipal Public Water Supply 0 Industrial 0 Stock <br /> 0 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: <br /> Storm Drainage System:i i 11 Potential Recharge Features:1 <br /> GROUNDWATER INFORMATION <br /> Depth(ft): SourcelDate of Reference: Groundwater Subbasin: <br /> Current Depth to Water: El Cosumnes Subbasin(2-22,16) <br /> Highest Depth to Water: El Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: 0 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.s'cehd.com <br /> 1 of 2 <br />