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cl <br /> 'r 'oP SA N JOAQUIN Environmental Health Department <br /> COUNTY <br /> IL ¢. Greatness grows here . <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number : Application Type : PREAPPLICATION SITE PLAN <br /> Project Address : 4215 , 4223 , & 4245 E MAIN STREET Project APN : 157-282-0241 -012 , -011 <br /> Applicant Name : MIKE JONES Title : ENGINEER <br /> Applicant Address : 1242 DUPONT COURT CIt /ZI : MANTECA 95336 <br /> Applicant Phone : 209-239 -6229 Email : MIKE@MCRENG . COM <br /> Property Owner Name : RAFAEL ZEPEDA <br /> Property Owner Address : 3833 N ARATA ROAD City/zip : STOCKTON 95205 <br /> Pro erty Owner Phone : 209-279-4203 Email : DAVIDZEPEDA2739GMAIL . COM <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply : CALWATER ❑ Surface Water (Attach Water Rights Information) <br /> Domestic Wastewater Disposal : <br /> Process Wastewater Discharge : Ponds : Applicable WDR : <br /> Storm Drainage System : <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallon s/Person /Day Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers : <br /> Type of Process/ Irrigated Lands Total Gallons/Da <br /> Process Water Usage . <br /> Process Water Usage , <br /> Irrigation Water Usage . <br /> Total Gallons Per Days <br /> PROPOSED WELL LOCATION <br /> Well Location Address : I Cit <br /> Well Location APN : <br /> Well Latitude : Well Lon itude : <br /> Flood Plain Designation : 1 Well Elevation : <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth (ft) : l Acres to be Served by Well : <br /> Use of Well : ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other : <br /> Depth of Corcoran Cla ft <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/mint <br /> Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume (acre -feet) : <br /> Estimated Cumulative Extraction Volume before January 1 , 2020 ( acre -feet) : <br /> SITING INFORMATION <br /> Distance To Nearest (ft) : Onsite : Offsite : Distance To Nearest (ft) : Onsite : Offsite . <br /> Wastewater Treatment System : Sources of Contamination : <br /> Other Wells : Pond/ Lake : <br /> Sewer Lines : Stream/River : <br /> Animal or Fowl Enclosure : I Navigable Waterway : <br /> Storm Drainage System : 1 System: Potential Rechar a Features : <br /> GROUNDWATER INFORMATION <br /> Depth (ft) : Source/Date of Reference : Groundwater Subbasin : <br /> Current Depth to Water : ❑ Cosumnes Subbasin ( 2-22 . 16 ) <br /> Highest Depth to Water : ❑ Eastern San Joaquin Subbasin (5 -22 . 01 ) <br /> Lowest Depth to Water : ❑ Tracy Subbasin ( 5 - 22 . 15 ) <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 - 0138 1 www . s * cehd . com <br /> 1 of 2 <br />