Laserfiche WebLink
SA _J OA Q U IN Environmental E deai ri. Depar Errnent� <br /> COUNT Y <br /> t:rca-ness o:a..., ! Crc_ <br /> Well Exemption Statement <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit <br /> additional information prior to the issuance of a permit by the Environmental Health Department. This form must be <br /> completed to document the exemption criteria applicable for the new well application. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: 1 5 9 8 8 E Eig t Mi i e RD City: Linden, <br /> Well Location APN: <br /> Applicant Name:j Soiari RancK Produce —Applicant Title:1 Owner <br /> Applicant Address: Box City: Linden, <br /> Applicant Phone:j 4Applicant email: avi cim I I r gmai .com <br /> Property Owner Name: o ari ancli Prod-u—ce <br /> Property Owner Address: PO Box 477 City:1 Linden <br /> Property Owner Phone: Property Owner email: ml lr 15 @ gmai 1 .com <br /> EXEMPTION CRITERIA <br /> Well meets any of the following Exemptions: <br /> ❑ Well not located in a critically overdrafted basin. ❑ Tracy Subbasin (5-22.15) ❑ Cosumnes Subbasin (5-22.16) <br /> R New well owner will be a de minimis extractor: maximum two acre-feet(651,702 gallons)or less per year being <br /> extracted for domestic purposes only. <br /> ❑ Replacement well with same extraction as the existing well that it is replacing. To meet this exemption the existing <br /> well must be destroyed under permit or continue to be used for domestic purposes with total domestic extractions <br /> remaining two acre-feet or less per year. <br /> Purpose/use of existing well: ❑ Serve an existing residence ❑ Irrigate residential landscape <br /> New well estimated annual extraction volume: <br /> Existing well estimated annual extraction volume: <br /> Total Annual Domestic Use Volume: <br /> ❑ Public agency that substantially meets or exceeds these requirements through another requirement of the law. In <br /> order to be exempt,the applicant shall document the laws that substantially meet or exceed these requirements <br /> and how the requirements of those laws were met. <br /> A city or county municipal well to provide water supply solely for residents of the city or county. <br /> I hereb rti that th ormation I have provided in this statement is accurate and truthful. <br /> Si need:' Date: �� <br /> Statement completed b : Well Driller ❑ Well/Property Owner ❑ Other: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />