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SANsJ0A0UIN <br />—COUNTY <br />Greatness grows 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 />��•��.yyy� r 1 <br />~ <br />..a P+'i :.,,, •..�i.. 1Y -. 4 ]fj� i! <br />1VYF a .-. <br />•F+•Well Location Address: <br />ICity: 20 <br />Well Location APN: <br />— <br />Well Latitude: <br />"� 22 Well Longitude: <br />— III - Z <br />Flood Plain Designation: <br />Well Elevation: <br />Applicant Name: <br />Applicant Title: <br />Applicant Address:19 <br />City: �n <br />Applicant Phone: <br />Applicant email: <br />Property Owner Name: <br />Properer Address: <br />ty Own <br />City: <br />Property Owner Phone: <br />Property Owner email: <br />s 11,1V <br />' c� <br />Well Total Depth ft). Acres to be Served by Well: <br />Use of Well: <br />❑ Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />O Other. <br />Depth of Corcoran Clay (ft): <br />Estimated Pumping Rate (ga <br />Proposed Well Capacity (galtft): Vmin): <br />Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume (acre-feet): <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />1868 E. Hazefton Avenue I Stockton, Califomia 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />