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PA2100 58 <br /> SAN J OAQ U 11r Environmental, -Aealth Department <br /> C tDt1 r-.l r `'' <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Pro'ect Address 1392 NBrlh Shaw gond Project APN: 1d3-aoo <br /> Applicant Name: Andrew Westbrook Title: <br /> Applicant Address: 19900 Harlan Road Cjt /Zj ; Slockian.CA MiS <br /> Applicant Phone;1(916)929-4680 Email: andrew@pactticmatorayclogroup.00m <br /> Property Owner Name: Andrewwaelarcak <br /> Property Owner Address: 13900 Harlan Rood City/Zip: Lathrop,CA ess.Jn <br /> Property Owner Phone; (91n1 9294400 Email: endrewrr47pacdlemoloreyeiegre�p,Gem <br /> SERVICES INFORMATION <br /> Please provide description beloW: Now saivice from Cal-Water at prosect Irontage <br /> Water Supply: 1-1/2' Water Service ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal:— Private septic systam <br /> Process Wastewater Discharge: Ponds: I NIR Applicable WDR: I NIA <br /> Storm Drainage System private Storm Water Retention pond <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/PersonlDa Total Gallons/Da <br /> Domestic Water Usage by Em Io eeslCustomers: 14 10 140 <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usa a: r41A <br /> Process Water Usage: N,A <br /> Irrigation Water Usage: Landscape 74 <br /> Total Gallons Per Day: 1214 <br /> _ PROPOSED WELL LOCATION <br /> Well Location Address: NA <br /> Well Location AM <br /> Well Latitude: Well Lan itude: <br /> Flood Plain_Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served b Well: <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 /> Pro osed Well Capacity alfft; Estima#ed Pum in Rate allmin <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., Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enplosure:1 Navigable Waterway:, <br /> _ Storm Drainage System] Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> De th ft; Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑Cosumnes Subbasin(222.16) <br /> Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑ Tracy Subbasin(5-22.15) <br /> 1868 E Hazelton Avenue I Stockton, California 95205 j T 209 46$-3420 1 F 209 464-0138 1 vwwv slcehcf com <br /> 111 2 <br />