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'$ SA6JOAQUIN Environmental Health Department <br /> COU NTY <br /> HrFc °"/ Greatne-ss grows here. <br /> Water Usage Information <br /> A <br /> pplicationmber: MOM Application Type: <br /> dress: 2662 N WILSON WAY, STOCKTON .C A 95205 Pro'ectAPN: <br /> Applicant Name: SARFRAZ AHMAD TABISH Title: CSO <br /> ddress:1012 WELLS OD City/Zip: LODI CA 95240 <br /> Phone:209-663-3117 Email: <br /> Property wner Name: SARFRAZ AHMAD TABISH <br /> Property er Address:1012 WELLSWOOD CT , Ci /Zi : LODI CA 95240 <br /> Owner Phone:209-663.3117 Email:jAutoMKhusa mail.com <br /> Please provide description below: <br /> California water Water Supply: ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Dis osal: <br /> Process Wastewater Discharge: Ponds: livable WDR: <br /> Storm Draina e S stem: <br /> Provide for total water usage at full buildoutue fJat� 1510 ..;. f <br /> Domestic Water Usage by Employees/Customers: 5/clay 0.5/P/D 2.5 G <br /> Process Water Usage: <br /> Process Water Usage: <br /> irrigation Water Usage: <br /> T Cb °!moi' 2.5 <br /> Well Location Address: N/A C' : <br /> Well Location APN: <br /> Well Latitude: I Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Well Total Depth(ft):1 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 Ca aci al/ft). Estimated Pumping Rate al/min <br /> Anticipated Pumping Schedule (gal/day): I Estimated Annual Extraction Volume(acre-feet):1 <br /> Estimated Cumulative Extraction Volume before January 1,2020acre-feet <br /> as <br /> Distance To Nearestft: 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 Drainage Systemd Potential Recharge Features: <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depthto Waterl MAI ❑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 i T 209 468-34201 F 209 464-0138 i www.sicehd.com <br /> 1 of 2 <br />