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PAlbO �j � � <br /> SQNa��OQQU � IV Environmental Health Department <br /> could-ry <br /> ,.,, nr.,es� o.�s „ <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> A lication Number: PA-1800170 SA A licafion T e: <br /> Pro ecl Adtlreas: 4250 E Mari sa Rtl Stockton CA 95215 Pro act APN: 1'19-160-20 <br /> licant Name: Lakhbir 3m h Mahti Tiga: Owner <br /> hCant Address: 3338 RuthartoW Drives CI /ZI 'u'[Onktgn.CA 85212 <br /> A licant Phone: 2094061731 Email: Lamahll® hoo.com <br /> Pro art Owner Names: Lakhbir singh M¢hit <br /> Pro a Owner Atltlress: 9338 Ruth¢rtortl Or Ci /Zi Stockton CA <br /> Pro Owner Phone: 2094061J31 ETBII: L.amahil@ ahnO.GOm <br /> SERVICES INFORMATION <br /> Please rovitle tlescd tion below: <br /> Westar Supply: Vyeg � Surface Water(Attach Water Rights/nformet/on) <br /> Domestic Wastewater Dis sat: naw sa tic tank <br /> Process Wastewater Dischar e: Ponds: A licable WDR: <br /> Sform Drains e S tam: ontl <br /> WATER USAGE DATA <br /> Protide for bta/water usa at ful/bul/lout Number Peraons/Da Gallona/Person/Da Total Gallons/Da <br /> Domestic Water Us a b Em to eas/Cusromere: s 1s 45 <br /> T e of Prooesa/Irri a[etl Lands Total Gallona/Da <br /> Process Water Usa e: Nona <br /> Process Water Usa e: Nona <br /> IM atlon Water Usa e: Nona <br /> Total Gallons Per D a5 <br /> PROPOSED WELL LOCATION <br /> Wall Locetlon Atltlresa: N/A CIL <br /> Well Location APN: <br /> Well Lati[utle: Well Lon nude: <br /> Flood Plain Desi nation: Well Elevation: <br /> PROPOSCO WELL INFORMATION <br /> Well Total De th ft: Acres to be Sarvetl b Well: <br /> Use of Well: O Domestic O In[gation D Small Public Water Supply O Municipal Public Water Supply � Intlustrial D Stock <br /> O Other: <br /> De fh of Corcoran Cla R <br /> Pro Deed Well Ca eci alHt: Estimated Pum in Rate al/min <br /> Antici a[etl Pum in Schedule al/da Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative EMraction Volume before Janus 7,2020 acre-feet <br /> SITING INFORMATION <br /> Dlatance To Nearest ft: Onslte: Offsite: Distance To Nearest ft: Onsite: Oftalte: <br /> Wastewater Treatment S tam: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/Riw3r: <br /> Animal or Fowl EnGosure: Nevi able Waterwa <br /> Storm Drains e S tam: Potential Rechar a Features: <br /> GROUNDWATER INFORMATION <br /> De h ft: Souroe/Data of Reference: Grountlwater Subbasin: <br /> Current Depth to Water: O Cosumnes Subbasin(2-22.16) <br /> Highest DepM to Water: O Easlem San Joaquin Subbasin(5-22.Ot) <br /> Lowest Depth to Water: o Tracy Subbasin(522.15) <br /> 1868 E. Haz¢Iton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0736 I www.sicehtl.com <br /> t of 2 <br />