Laserfiche WebLink
SAN JOAQU IN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> New Well Information <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption <br /> criteria must submit the following required information, to the extent that can be reasonably known. <br /> The Environmental Health Department must collect this information before a new well permit is <br /> issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: ZclpL ,��1 City: CL 6 <br /> Well Location APN: 2-5 <-3 5 ti 5-0 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Ca Applicant Title: <br /> Applicant Address: �56 y C,{ e;,4,, City: So Uep/t D <br /> Applicant Phone: (),0 11 Z _ 3 Applicant email: C So w io o-1 u d o 6 C'c+ <br /> Property Owner Name: A/V/V e-ffe .0c — 044 o Wd A�l <br /> Property Owner Address: 7 2 It w 'TKA—cCity: 7S-Do _ <br /> Property Owner Phone: Property Owner email: _— <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: <br /> Use of Well: ❑ Domestic Xlrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ 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): EA <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: b <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: <br /> [I Domestic El Irrigation ❑ Small Public Water Supply El Municipal Public Water Supply El Industrial El Stock <br /> Use of Well:� <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />