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SAN 10 A Q U I N Environmental Health Department <br /> ---COUI`JTY- <br /> Water Usage Information PA2 100 1 <br /> PROJECT INFORMATION <br /> Application Number: Application Type. <br /> Project Address: 0.:�> 4.1 M c S5C) C) L 7AOZ S-> Project APN: <br /> Applicant Name: pt I KC7 i�R-0µ/'i Title: 71/_ - <br /> Applicant Address: j>,C), 13 JX 1 l O L A7 IKOP Z S '0 i A ,/Zip: <br /> Applicant Phone-1 2,•-=9 Email:Vj s o-oo <br /> Property Owner Name: oSSi �iSSoei S <br /> Property Owner Address: p u 7 2 Ci /Zi :LA P VJ 1_?c-D <br /> Property Owner Phone: Zc7 ok I Email: <br /> SERVICES.INFORIVIATION <br /> Please provide description below: 1«t7a _D <br /> Water Supply: N A- <br /> II SIa.dace Water_(poach Wafer Rights:lntormafion)a:. <br /> Domestic Wastewater Disposal: <br /> Process Wastewater Discharge: Ponds: A. Applicable WDR: <br /> Storm Drainage System: NIA <br /> WATER USAGE DATA <br /> Provide for total water usage of full buildout Number Persons/Day_ Gallon /Person/Day Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers N46 <br /> Type of Process/irrigated Lands Total Gallons/Da <br /> Process Water Usage: fj >. <br /> Process Water Usage: k <br /> Irrigation Water Usage: N ^ <br /> Total Gallons Per Da <br /> l <br /> PROPOSED WELL L0CATM <br /> Well Location Address: NZA Ci : <br /> Well Location APN: Kt <br /> Well Latitude: b I Well Longitude-.1 <br /> Flood Plain Designation: I Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well:Total Depth:( A as to be Served by Wella: <br /> Use f 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 (gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet):. <br /> - <br /> Estima #,Cumulative Extraotio i Vvivrne tiefor Jartti -1,-2020 <br /> SITING INFORMATION <br /> Distance To Nearest(ft): On.ite: Offsite: Distance To Nearest(ft): Orfske: Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure:. Novi able Waierwa :. <br /> Storm Drainage System: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: r11A ❑Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ❑Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth-to plater i` ❑Tracy Sub basin(5222.15) <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 />