Laserfiche WebLink
§),-- °�� SANDJOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <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 /> Z..1441�nel <br /> was W- <br /> Well location Address: 122KA y City: <br /> Well Location APN: — — <br /> Well Latitude: Well Longitude: — Z <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: a l Applicant Title �( <br /> Applicant Address: Z')1 Z City: MMACAJ <br /> Applicant Phone: — Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PRQ�QFfNJ <br /> Well Total Depth(ft): Acres to be Served by Well: 2 <br /> 11 <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(galfft): Estimated Pumping Rate(gallmin): <br /> Anticipated Pumping Schedule(gallday): Estimated Annual Extraction Volume(acre-feet):- I <br /> - <br /> Anticipated <br /> Cumulative Extraction Volume before January 1,2020(acre-feet): <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: ' omestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): <br /> To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Specific Capacity(gal/minlft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazefton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />