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4200/4300 - Liquid Waste/Water Well Permits
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WP0042498
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Last modified
5/4/2022 2:29:05 PM
Creation date
5/4/2022 2:14:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042498
PE
4370
STREET_NUMBER
0
STREET_NAME
FAIRCHILD
STREET_TYPE
RD
City
STOCKTON
Zip
95215-
APN
08911023
ENTERED_DATE
9/1/2021 12:00:00 AM
SITE_LOCATION
0 FAIRCHILD RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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SAN."IOAQUIN <br />COU NTY---- <br />F� vironmental Health Department <br />Well Exemption Statement <br />Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit <br />additional information prior to the issuance of a permit by the Environmental Health Department. This form must be <br />completed to document the exemption criteria applicable for the new well application. <br />WELL LOCATION AND OWNER INFORMATION <br />Well Location Address: <br />Fairchild Rd <br />City:j Stockton, <br />Well Location APN: <br />0 8 91 1 023 <br />extracted for domestic purposes only. <br />Applicant Name: <br />Ghio Farms <br />Applicant Title: owner <br />Applicant Address: <br />11222 E Fairchild Rd <br />City. Stockton <br />Applicant Phone. <br />209-401-1305 <br />Applicant email 81955@ve outer. <br />New well estimated annual extraction volume: <br />Property Owner Name: <br />same <br />Property Owner Address: <br />Total Annual Domestic Use Volume: <br />City: <br />Public agency that substantially meets or exceeds these requirements through another requirement of the law. In <br />Property Owner Phone: <br />Property Owner email: <br />EXEMPTION CRITERIA <br />Well meets any of the following Exemptions: <br />❑ <br />Well not located in a critically overdrafted basin. ❑ Tracy Subbasin (5-22.15) ❑ Cosumnes Subbasin (5-22.16) <br />® <br />New well owner will be a de minimis extractor: maximum two acre-feet (651,702 gallons) or less per year being <br />extracted for domestic purposes only. <br />❑ <br />Replacement well with same extraction as the existing well that it is replacing. To meet this exemption the existing <br />well must be destroyed under permit or continue to be used for domestic purposes with total domestic extractions <br />remaining two acre-feet or less per year. <br />Purpose/use of existing well: ❑ Serve an existing residence ❑ Irrigate residential landscape <br />New well estimated annual extraction volume: <br />Existing well estimated annual extraction volume: <br />Total Annual Domestic Use Volume: <br />❑ <br />Public agency that substantially meets or exceeds these requirements through another requirement of the law. In <br />order to be exempt, the applicant shall document the laws that substantially meet or exceed these requirements <br />and how the requirements of those laws were met. <br />❑ <br />A city or county municipal well to provide water supply solely for residents of the city or county. <br />hereby certify that the information I have provided in this statement is accurate and truthful. <br />Signed: Date: C1 <br />Statement completed by: ® Well Driller ❑ Well/Property Owner ❑ Other: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />iet <br />
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