Laserfiche WebLink
SAN J O A Q U I N Environmental Health Department <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: 1 Applicolon Type: _ <br /> Pro ect Address: P. <br /> ect APN: 3- O -- <br /> Applicant Name: Title: <br /> Applicant Address: — Ci 2i <br /> Applicant Phone: ' Email: G �. <br /> Property Owner Name: _ wvy A <br /> Property Owner Address: •,wv. -.r ci /zi : <br /> Property Owner Phone: f.0 - - S Email: <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: <br /> C 1 ClSurface Water(Attach Water Rights Information) <br /> Domestic Wastewater Dis osal: <br /> Process Wastewater Dischar e: Ponds: Applicable WDR: <br /> Storm Draina e S stem: U,,/z,44 <br /> WATER USAGE DATA - <br /> Provide for total water usage at full buildout Number Persons/DayGallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usa e: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Day: <br /> PROPOSES WELL LOCATION <br /> Well Location Address: city: <br /> Well Location APN: <br /> Well Latitude,j on itude: <br /> Flood Plain Designation:[ Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft),[ Acres to be Served.by Well: <br /> Use of Well: L-I Domestic 0 Irrigation o Small Public Water Supply Cl Municipal Public Water Supply 0 Industrial O Stock <br /> 0 other: <br /> Depth of Corcoran Clay ft <br /> Proposed Well Capacity al/ft: Estimated Pumping Rate al/min <br /> Anticipated Pumping Schedule al/da Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative Extraction Volume before January1,2020(.cre-feet <br /> SITING INFORMATION <br /> Distance To Nearest(ft): Onsite: Offsite: I I Distance To Nearest(ft): I Onsite: F Offsite: <br /> Wastewater Treatment System!! Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines,l I Stream/River: <br /> Animal or Fowl Enclosure: Navigable Waterwa <br /> Storm Drainage System:1 I I ISystem: Potential Rechar a Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): I Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water:1 O Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: O Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: D Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.corn <br /> 1 of 2 <br />