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SAN 10AQUINa <br /> Environmental Health Department <br /> COUNTY <br /> s Greatness grows here <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: 18846 St.Rt.99 E Frontage Rd.Lodi,CA 95220 Project APN: 017-090-51 <br /> Applicant Name: Jeff Crothers Title: <br /> Applicant Address: 119 E.weber Ave. Cit /Zip: Stockton/95202 <br /> Applicant Phone: (209)-986-4150 Email: Jeffcrothers@aol.com <br /> Property Owner Name: Jeff Crothers <br /> Property Owner Address: 119 E.weber Ave. City/Zip: Stockton/95202 <br /> Property Owner Phone: f209j-986-4150 Email: Jeffcrothers@aol.com <br /> SERVICES INFORMATION <br /> Please provide description below: Private well <br /> Water Supply: Private Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: Private Septic System <br /> Process Wastewater Discharge: Ponds: I Existing F Applicable WDR: <br /> Storm Drainage System:: On-Site Retention <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: 75 25 1875 <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Day: <br /> PROPOSED WELL LOCATION <br /> Well Location Address: N/A Cit : <br /> Well Location APN: <br /> Well Latitude: Well Longitude] <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 Acres to be Served by WeII: <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity al/ft): Estimated Pumping Rate (gal/min): <br /> Anticipated Pumping Schedule (gal/day): 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: ONSITE 120 Sources of Contamination: N/A N/A <br /> Other Wells: ONSITE 170 Pond/Lake: ONSITE N/A <br /> Sewer Lines: N/A N/A Stream/River: N/A 1500 <br /> Animal or Fowl Enclosure: N/A N/A Navigable Waterway: N/A N/A <br /> Storm Drainage System]ONSITE Adjacent Potential Recharge Features: N/A N/A <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: 150 Groundwater Information Center Interactive Map App. ❑ Cosumnes Subbasin (2-22.16) <br /> Highest Depth to Water: 160 Groundwater Information Center Interactive Map App. ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: 140 Groundwater Information Center Interactive Map App. ❑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 />