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SA 'Q Q O U I N Environmental He <br /> atth partment <br /> --- _ j r,.j T'Y' - <br /> Water Usage Information F, <br /> PROJECT INFORMATION a <br /> Application Number: A plication T <br /> Project Address: J Pro'ect APN: <br /> -- Applicant Name: Title: Jlf- <br /> Applicant Address: a Ci I i : <br /> Applicant Phone: 7�, `��' ;r Email: � � <br /> Property Owner Name: �-��nk S 'n v10 tti1�,�c c r- un 0 <br /> PropertyOwner Address: , , , Ci 1Zip: <br /> Property.Owner Phone: — -- -7 Email <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: c At. Wig' ❑ Surface Water(Attach Water Fights lnfarrrtatior�� <br /> Domestic Wastewater Disposal: I 5-,-k _3AV\-F5A -' Ly '�-- <br /> Process Wastewater Discharge: Ponds: I Applicable WDR: <br /> Storm Drainage System: ("') <br /> WATER USAGE DATA Total Gallons/Da <br /> Provide for fatal water usage at full buildout Number Persons/Day GallonslPerson/Da <br /> Domestic Water Usage b Employees/Customers: 0 Ia <br /> Type of Process/Irrigated Lands Total GallonslDa <br /> Process Water Usa e: c <br /> Process Water Usage: <br /> Irri ation Water Usage: <br /> Total Gallons Per Day <br /> PROPOSED WELL LOCATION ' <br /> City" f' <br /> Well Location Address: <br /> Well Location APN: Well Lon itude: <br /> Well Latitude: <br /> Well Elevation: <br /> Flood Plain Desi nation: <br /> PROPOSED WELL INFORMATION <br /> Acres to be Served by We1l <br /> Well Total Depth(ft: <br /> ❑Domestic ❑ Wgation ElSmall Public Water Supply ❑Municipal Public Water Sdpp(y ❑Industrial ❑Stock <br /> Use of Well: <br /> ❑Other: <br /> Depth of Corcoran Cla (it: Estimated Pumping Rate allmin <br /> Proposed Well Capacity. allft: Estimated Annual Extraction Volume acre-feet}; <br /> Antici ated Pumping Schedule allda : <br /> Estimated Cumulative Extract(o olume before Janua 1,2020 acre-feet): <br /> J. <br /> SITING INFORMATION <br /> Offsjw Distance To Nearest(ft): Onsite: Offsite: <br /> Distance To Nearest ft: Onsite: , Sources of Contamination: <br /> Wastewater Treatment System: Pond/Lake: <br /> Other Wells: Stream/River: <br /> Sewer Lines:1 Navi able Waterwa : <br /> Animal or Fowl Enclosure: >� potential Recharge Features: <br /> Storm Drainage S stem:.: <br /> GROUNDWATER INFORMATION Groundwater Subbasin: <br /> Depth ft : Source/Date of Reference: <br /> ❑ <br /> Current Dept t6V�later: Cosumnes Subbasin(2-22.16) <br /> Highe�D'e <br /> ElEastern San Joaquin Subbasin(5-22.01) <br /> pth to Water: <br /> . El Tracy Subbasin(5-22.15) <br /> Lot"ti,est Depth to Wafer <br /> 1868 E. Hazelton Avenue f Stockton, California 95205 I T 209 468-3420 1 <br /> F 209 464-0138 sjcelid.com <br /> 1 of 2 <br />