Laserfiche WebLink
°r° .` SAKd0A0UIN <br />COUNTY <br />"s? Greatness qrows here. <br />Environmental Health Department <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 <br />known. The Environmental Health Department must collect this information before a new well <br />permit is issued and must post the information on the Department's website for public information. <br />WELL`LO.CATION -AND :OWNEIINFORMATION <br />Well Total Depth (ft): <br />Well Location Address: <br />City: 9; <br />Well Location APN: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Well Latitude: <br />Well Longitude: <br />F-1 <br />Flood Plain Designation: <br />Well Elevation: <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />Applicant Name: <br />Applicant Title: W <br />Applicant Address: , . �'� <br />City: <br />3 <br />Applicant Phone: <br />Applicant email: <br />Specific Capacity (gaUmin/ft): <br />Property Owner Name: <br />Other Pumping Tests Performed: <br />Property Owner Address: <br />City: <br />Property Owner Phone: <br />Property Owner email: <br />PROPOSED WELL, INFORMATION'��,"T , <br />Well Total Depth (ft): <br />Acres to be Served by Well: (� <br />[Use of Well: <br />❑ Domestic '1� Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Proposed Well Capacity (gal/ft): <br />❑ Domestic ❑ Irrigation <br />❑ Other: <br />Estimated Pumping Rate (gaVmin): <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />From: <br />From: <br />From: <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />EXISTING .WELLSIUFORMATION <br />10. <br />Total Number of Existing Wells on Property: <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #1 Information <br />_ <br />Use of Well: <br />❑ Domestic ❑ Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ElMunicipal Public Water Supply ElIndustrial ElStock <br />Total Depth (ft): <br />To: <br />❑ Open Bottom or Screen Interval (ft): To: <br />To: <br />From: <br />From: <br />From: <br />Casing Diameter (in): <br />Pumping Rate (gpm): <br />Annual Extraction Volume (acre-feet: <br />❑ Estimated ❑ Measured <br />Specific Capacity (gaUmin/ft): <br />Other Pumping Tests Performed: <br />Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 4(38-3420 1 F 209 464-0138 1 www.sjcchd.com <br />