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SAN ,JOApUIN Environmental Health Department <br /> _�. i- COUNTY - <br /> ,,,,,. Gree roses yrows here-. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> A lica4on Number: A lication T e: <br /> Pro eel Atldress: aoozz wenwey ss.T.e�y cA,sssoa Pro eM APN: zss-ozo-no-000 <br /> A lieant Nam@:Alen rook Title: c a=�eea�nae. <br /> A IG3nt Addr@Ba: 9a3a W anew Ava CII /ZI Fresno CA 9311+ <br /> A Iicant Phone: (see>aaz-sale Email eent$ai®nnwxenameeane.com <br /> Pro rt Owner Name: cAaa rr= <br /> P!O B OWrI@r Addr@es: +4+5+Newport Ava.Sb.z03 Clt /ZI ua[In CA 92]ae <br /> Pro art Owner Phone: Email: eumenemm®amen.==m <br /> SERVICES INFORMATION <br /> Please rovide descri tion below: <br /> Water Supply: proposed Wall O Surtac@ Water(Attach Water R/ghts/nRlrmetion) <br /> Domestic Wastewater Dis Deal: cone eyerem <br /> Process Wastewater Dlschar e: Pontls: Leecn imm A licable WDR: <br /> Storm Drains e S stem: o..-wte raanuan eeein <br /> WATER USAGE DATA <br /> Protide for tote/water use eat fu//bu//clout Number Persons/Da Gallona/Person/Da Total Gallons/Da <br /> Domestic Water Use e b Em to s/Customers: +so +a +soo <br /> T e of Procesa/Irti sled Lentls Total Gallons/De <br /> Process Water Usa e: o <br /> Process Water Usa e: o <br /> Irri atlon Water Us e: +zc <br /> Total Gallons Per Da +azo <br /> PROPOSED WELL LOCATION <br /> Well Location Atltlress: aooaz I-ignway as Ci : lrncy <br /> Well Location APN: zss-ozo-++o-000 <br /> Well Latitutle: azeaslsa W@II Lon nude: -+z+.aaos+a <br /> Flood Plain Desi natlOn: FEMA Unmeppatl WBII EIBVatIOn: 80.0' <br /> PROPOSED WELL INFORMATION <br /> Well Total De lh ft: zso Acres to be Servetl b Well:a <br /> Use of Well: � Domestic O Irrigation O Small Public Water SupPIY O Municipal Public Wa[ar Supply O Industrial O Stock <br /> o Other: <br /> De hof Corcoran Cla ft: unxnw..n <br /> Pro os@tl Well Ca sell al/ft: unmown Estimatetl Pum in Rate a4m{n : so <br /> An[ici atetl Pum In Schetlule al/da +azo Es[imaletl Annual Extraction Volume acre-feet: o.z1 <br /> Eafimatetl Cumulative Extraction Volume before Janus 1 2020 acre-fee[ <br /> SITING INFORMATION <br /> Distance To Nearest h: Onalte: Offsite: Diatanea To Naareat H: Onalte: OHalte: <br /> Wastewater Treatment S stem: coo•+ eoo�. Sources of Contamination: wA soo•. <br /> Other Wells: rv/A sov. PonWLake:e+s/swrm arem eeam> soo•. <br /> Sewer Lines: zso�. Stream/River: wA +so•+r@clo ce..eq <br /> Animal or Fowl Enclosure: r/A soo•= Navi able Watarwa wA rv/A <br /> Storm Drains e 5 stem: s+s• soo�• Potential Recha a Features: eco•+ <br /> GROUNDWATER INFORMATION <br /> De th R: Souroe/Dat@ of Reference: Grountlwater Subbasin: <br /> Curtent Depth to Water: 60' SJC Public Works 201 B O Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: 40' SJC Public Works 2016 p Easl@rn San Joaquin Subbasin(5-22.01) <br /> Lowest D@plh to Water: OB' SJC Public Works 2016 p Tracy Subbasin 5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicand.com <br /> t oft <br />