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SAN 10 A Q U I N Environmental Health Department <br /> -----COU NY <br /> T <br /> , . <br /> Water Usage Information PA2200049 <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: 21199 San Jose Rd Project APN: <br /> Applicant Name:Sri Veda Vid a Peetham Title: <br /> Applicant Address:21199 San Jose Rd City/Zip:Tracy 95304 <br /> Applicant Phone:925-980-9257 Email:isvvip.org@qmail.com <br /> Property owner Name:Venkateshwar Chinta alli Manik a Prabhu Salveru Shiva Kiran Nori <br /> Property Owner Address:21199 San Jose Rd I City/ZipjTracy 95304 <br /> Property Owner Phone: I Email:svv .or @ mail.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: Existing Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: Exi tina Se tic <br /> Process Wastewater Discharge: Ponds: Inone Applicable WDR: <br /> Storm Drainage System: Natural Drainage <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: 5 1100 gallons ------100 Gallons <br /> _ <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Da <br /> PROPOSED WELL LOCATION <br /> Well Location Address: <br /> Well Location APN: <br /> Well Latitude: Well Lon itude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total De th ft: Acres to be Served b Well: <br /> Use of Well: ❑Domestic ElIrrigation 11Small Public Water Supply ElMunicipal Public Water Supply ❑ Industrial 11 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 /> 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: Navi able Waterwa <br /> Storm Drainage System:j 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. F-lazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> 1 of 2 <br />