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PA2 ? 00033 <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: 7-1,,,410 _ r eXAPr Project APN: (0 <br /> Applicant Name: 6A Title: <br /> Applicant Address: T Cit /Zi -VU 1Z06L► <br /> Applicant Phone: &I . 24-,0 Email: C' S i L Aber <br /> Property Owner Name: Ce L,�r Pc .P T-4 � <br /> Property Owner Address: j ot, M en1' L . City/Zip: <br /> Property Owner Phone: — 33— , r Email: 5"C �}/ <br /> SERVICES INFORMATION <br /> Please provide description below: �1:C _ <br /> Water Supply: Fondsk7 <br /> ��� / F1rC OLS ❑ Surface Water(Affach Wafer Rights Information) <br /> Domestic Wastewater Dis osal:Process Wastewater Dischar e: Applicable W R: <br /> Storm Drainage System: f u ti) L c -"L C 7­0 t Ax tL <br /> WATER USAGE DATA <br /> Provide for total wafer usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: 7— , <br /> Type of Process/Irri ated Lands Total Gallons/Da <br /> Process Water Usage: WAS y 1(' _ V <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Day; <br /> PROPOSED WELL LOCATION <br /> Well Location Address: Cit <br /> Well Location APN: <br /> Well Latitude: v Well Lon itude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well TotaTDe ft: Acres to be Served b Well:Use of WDomestic ❑ 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 /> 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 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. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> 1 of 2 <br />