Laserfiche WebLink
SAN J O A Q U I N Environmental Health Department <br /> -C- O lJ IV-I-Y <br /> Gres. ,. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: PA-z3ooz=< Application Type: cendmm�m mea Pe.m1. <br /> Project Address soot s1®mev Radd.sw�pw�.ca sszl s Project APN: 1s�-os-ozs <br /> Applicant Name: — mama Title: nwndd=ed o...,as Fiep.esam>d�a <br /> A Iicant Address: —1.N.-Rd Cit /ZI B—nl.on o+ooz <br /> Applicant Phone: —asoos+ Email:Ip.eana�®vanoo.�om <br /> Property Owner Name• suvnT— <br /> Pro a Owner Address: —1z Nponnd Ci /Zi ' ammo+<cn s+ooz <br /> Property Owner Phone: sso.soos+ Email: p.esna�dPranoowm <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: Existing on-site well O Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: ......—d.,—o.,-sua.-1..-.m <br /> Process Wastewater Dischar e: Ponds: Nin A Iicable WDR: I— <br /> Storm Drainage System: oo-sua swawa <br /> WATER USAGE DATA <br /> Provide for total wafer usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: 1s zdd <br /> Type of Process/]rri ated Lands Total Gallons/Da <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: umued d.ouem mie.anuenaseep�na so <br /> Total Gallons Per Day: zso <br /> PROPOSED WELL LOCATION <br /> Well Location Address: Ci <br /> Well Location APN: <br /> Well Latitude: Well Lon nude: <br /> Flood Plain Designation:1 I Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft),j Acres to be Served by Well: <br /> Use of WeII: E3 Domestic O Irrigation E3 Small Public Water Supply E3 Municipal Public Water Supply O Industrial O Stock <br /> E3 Other: <br /> Depth of Corcoran Cla ft: <br /> Proposed Well Capacity alfft: Estimated Pumping Rate al/min <br /> Anticipated Pum in Schedule al/da : 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: Navi able Waterwa <br /> Storm Draina e S tem: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water:1 i =Gosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ® Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: 0 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.sicehd.com <br /> 1 of 2 <br />