Laserfiche WebLink
SAN JOAQUIN a <br /> Environmental Health Department <br /> r + <br /> —COUNTY--- <br /> `ct+ ri. Greatness arows ner <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 known. <br /> The Environmental Health Department must collect this information before a new well permit is <br /> issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: 2 City: <br /> Well Location APN: 2DO <br /> Well Latitude. Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Applicant Title: Hj�J <br /> Applicant Address: e. City: <br /> Applicant Phone:1 2,04 DL O Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 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 Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gallmin): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 1 <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <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 /> Use of Well: ElDomestic ElIrrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial E.Stock <br /> ❑Other.- <br /> Total <br /> ther:Total Depth(ft): To: From.- <br /> Casing <br /> rom:Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed:j Test Result: <br /> 1858 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.3jcehd.com <br />