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0 81 <br /> SAN J O A Q U I N Environmental Health Department <br /> COUNTY — <br /> �rea��es� <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: 10946 S.Airport way,Manteca Project APN: 204-020-04 <br /> Applicant Name: Parry Dalzell Title: Pastor <br /> Applicant Address: 10946 S.Airport way, City/Zip: Manteca,Ca.95336 <br /> Applicant Phone: 209-565-9822 Email: parrydalzell@gmall.com <br /> Property Owner Name: Central valley Baptist Church <br /> Property Owner Address: 10948 S Airport way Cil /Zip: Manteca.Ca.95336 <br /> Property Owner Phone: 209-565-9822 Email: parrydalzell@gmali,com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: Existing Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: Septic <br /> Process Wastewater Discharge: Ponds: Applicable WDR: <br /> Storm Drainage System: I Storm Fond <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Day Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: varies <br /> Type of Processtlrri ated 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: I Ci <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: I Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ftfl Acres to be Served by Well: <br /> Use of Well: ❑Domestic ❑Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Cla (ft <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate al/min); <br /> Anticipated Pumping Schedule(galldayj I Estimated Annual Extraction Volume acre-feel): <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 Enclosure: Navigable Waterway: <br /> Storm Draina e System:l I I System: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑ Cosumnes Subbasin(2-22.16) <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 1 T 209 468-3420 l F 209 464-0138 1 www.sicehd.com <br /> 1 of 2 <br />