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�A I`I� <br /> J Q Q Q U I N Environmental Health Department <br /> -COUNTY— <br /> , -' ; <br /> .`'q�,Poa <br /> �X° Greatness grows here, <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: Use Permit <br /> Project Address: 12825 Bethany Road,Tracy,CA 95304 Project APN: 212-020-07 <br /> Applicant Name: Tulasl C.Tummala Title:- <br /> Applicant <br /> itle:A licant Address: 1366 Suzanne Court City/Zip: San Jose,CA 95129 <br /> Applicant Phone: 408-786-8357 Email: tulasict@yahoo.com <br /> Property Owner Name: Datta Yoga Center <br /> Property Owner Address: 1366 Suzanne Court City/Zip: San Jose,CA 95129 <br /> Property Owner Phone: 408-786-8357 Email tulaslctCl°yahoo.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: Private well to be constructed with Phase 1 development ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: On-site leach field(s)to be constructed with Phase 1 development <br /> Process Wastewater Discharge: Ponds: I I A licable WDR: <br /> S <br /> Storm Drainage stem: On-site retention basin to be constructed with Phase 1 development <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: 165 average 3 495 <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: ,Limited,law impact landscaping 500 <br /> Total Gallons Per Da : 995 <br /> PROPOSED WELL LOCATION <br /> Well Location Address: 12925 Bethany Road,Tracy,CA 95304 Cit : Tracy <br /> Well Location APN: 212-020-07 <br /> Well Latitude: 37,78 Well Longitude: -121.46 <br /> Flood Plain Designation: AE Well Elevation: to he determined <br /> PROPOSED WELL INFORMATION <br /> Well Total De th ft tobedetermined Acres to be Served b Well 10 developed acres <br /> Use of Well: <br /> ❑ Domestic 0 Irrigation 0 Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): tobed etermined <br /> Proposed Well Capacity (gal/ft): tebedetermined Estimated Pumping Rate (gal/min): tobedetermined <br /> Anticipated Pumping Schedule (gal/day): tebedetermined Estimated Annual Extraction Volume(acre-feet): to be determined <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: 200- Sources of Contamination: none <br /> Other Wells: none Pond/Lake: none <br /> Sewer Lines: >50- Stream/River: none 2000'to old River <br /> Animal or Fowl Enclosure: none Navigable Waterway: none <br /> Storm Drainage System]500' 200' Potential Recharge Features: 500' 200' <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: to he determined ❑ Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: to be determined ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water:1 to be determined 0 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.sacehd.com <br /> 1 of 2 <br />