Laserfiche WebLink
SAW-JOAQUIN Environmental Health Department <br /> Great.n'ess grows f e, <br /> Water Usage Information 1 <br /> PROJECT INFORMATION <br /> .: <br /> Application Number: Application Type: <br /> Project Address: CjotProject APN: <br /> Applicant Name: Title: <br /> Applicant Address: 5 City/Zip: IS <br /> Applicant Phone: &cq_ Email: q 3 i I . <br /> Property Owner Name: rCr A <br /> Property Owner Address: Ci /Zi <br /> Property. .......... _ _........ __ <br /> SERVICES;'INFORMATION <br /> _: <br /> Please provide description below: <br /> Water Supply: ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: <br /> Process Wastewater Discharge: ApplicableWDR: <br /> Storm Drainage System: <br /> .. <br /> _..... .... _. .. _ ...... <br /> .: <br /> >WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: <br /> Type of Process/Irrigated.Lands Total GallonslDa <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Da <br /> PROPt?SED WELL 0 CATION <br /> Well Location Address: City: <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> PRGI'DSIE"tf WELL INFORMATION. <br /> Well Total Depth(ft: 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 Clay(ft): <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate gallmin <br /> Antici ated 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 Enclosure: Navigable Waterway: <br /> Storm Draina e System:j i System: Potential Recharge Features: <br /> 5ROUNBWA'ER INFORMATION <br /> Depth ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: coo ❑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 1 F 209 464-0138 1 -vVww.Slcehd.com <br /> 1 of 2 <br />