Laserfiche WebLink
SAN J OAQ U I N Environmental Health Department <br /> _COUNTY <br /> �.,r�;;tr:FsS 3r'oss tie: <br /> New Well Information <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption <br /> criteria must submit the following required information, to the extent that can be reasonably known. <br /> The Environmental Health Department must collect this information before a new well permit is <br /> issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: QP City: 5TDG A <br /> Well Location APN: S 3 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevatio7"_ <br /> Applicant Name: �� �,,t,g L Applicant Title: �>7 Kp�,/o✓ <br /> Applicant Address: 1�)Ib 4W &F( City: n d110 <br /> Applicant Phone: 0 R, ?S17_35sq Applicant email:, u re vi�►✓�a C� Co►!a✓ <br /> Property Owner Name: <br /> -JR nbe,,d 4 3etyv'te, FMZ,­i ryl <br /> Property Owner Address: ( 3 Z3 wee i � City: �ih N <br /> Property Owner Phone: 481 Property Owner email: s rmP2(03 V e acxa �{E <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 5 O F-7 Acres to be Served by Well: Vo <br /> Use of Well: ❑ Domestic W Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): ('(ct <br /> Proposed Well Capacity(gal/ft): 7 Estimated Pumping Rate(gal/min): -700 <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): g <br /> Estimat d Cumulative Extraction Volume before January 1,2020(acre-feet): (� <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: <br /> Please complete the information below for every well on property.Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: ❑Domestic ® Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): 1-(2 To: From: <br /> Casing Diameter(in): I '0 Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 7oo To: From: <br /> Annual Extraction Volume(acre-feet: g8 ® Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): f s <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />