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SA NJ OAQU IV Environmenta , Health Department <br /> COUNTY <br /> = , 10N Greatness grows here . <br /> Water Usage Information <br /> PROJECT INFORMATION - <br /> Application Number: Application Type : LASfZ 4)e� - <br /> Project Address : jo J &% R Project APN : •wol <br /> Applicant Name : M^Q45 Title : de '' <br /> Applicant Address : l City/Zip : j <br /> Applicant Phone : - 5 -A40118 Email : � �� <br /> Property Owner Name : `pj <br /> Property Owner Address : ?0 bo City/Zip : 2 <br /> Property Owner Phone : i � &Jlc& Lo t Ljlr Email - ' a <br /> SERVICES INFORMATION - - <br /> Please provide description below : <br /> Water Supply : ❑ Surface Water (Attach Water Rights Information) <br /> Domestic Wastewater Disposal : <br /> Process Wastewater Discharge : Ponds : Applicable WDR : <br /> Storm Drainage System : <br /> - WATER USAGE DATA <br /> Provide for total wafer usage at full buildout Number Persons/ Da Gallons/Person / Day Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers : t I d <br /> Type of Pr ss/irrigated La Total Gallons/Day <br /> Process Water Usage : <br /> Process Water Usage : <br /> Irrigation Water Usage : <br /> Total Gallons Per Day : <br /> PROPOSED WELL LOCATION <br /> Well Location Address : 0City ] r a <br /> Well Location APN : A <br /> Well Latitude : Well Longitude : <br /> Flood <br /> on itude :Flood Plain Designation : 1 PVcod, fALAo,,) Well Elevation : <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth (ft) : 1 1 _ - Acres to be Served by Well : <br /> Use of Well : <br /> Domestic .► Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other : <br /> Depth of Corcoran Clay (ft) : Z <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): <br /> Anticipated Pumping Schedule al/q Qje Estimated Annual Extraction Volume (acre-feet): <br /> Estimated Cum ative Extraction Volume before January 1 , 2020 (acre -feet): <br /> SITING INFORMATION <br /> Distance To Nearest (ft) : Onsite : Offsite : Distance To Nearest (11) : Onsite : Offsite : <br /> Wastewater Treatment System : / Sources of Contamination : L <br /> Other Wells : . �p Pond/Lake : <br /> Sewer Lines : Stream /River: <br /> Animal or Fowl Enclosure : Navigable Waterway : 23 <br /> Storm Drainage System : uQri ,p1 Potential Recharge Features : <br /> GROUNDWATER INFORMATION <br /> Depth (ft) : Source/Date of Reference : Groundwater Subbasin : <br /> Current Depth to Water : ElCosumnes Subbasin ( 2 -22 . 16 ) <br /> Highest Depth to Water: ` - , 4 ❑ Eastern San Joaquin Subbasin (5 -22 . 01 ) <br /> Lowest Depth to Water . . ) Ud ❑ Tracy Subbasin ( 5 -22 . 15) <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 1 www . sicehd . com <br /> 1 of 2 <br />