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SAN JOAQUIN Environmental Health Department <br /> - - - - COUNTY <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number : Application Type : <br /> Project Address : 10464 99 FRONTAGE ROAD , STOCKTON , CA Project APN : 086-07-34 <br /> Applicant Name : JASBIR CHEEMA Title : OWNER <br /> Applicant Address : 4053 E . MORADA LANE Cit /Zip : STOCKTO , 95212 <br /> Applicant Phone : 209-323-9334 Email : DOCTOCHEEMA@YAHOO . COM <br /> Property Owner Name : JASBIR CHEEMA <br /> Property Owner Address : 4053 E . MORADA LANE Cit /Zip : STOCKTON / 95212 <br /> Property Owner Phone : 209-3223-9334 Email : DOCTOCHEEMA@YAHOO . COM <br /> SERVICES INFORMATION <br /> Please provide description below : WATER FOR DOMESTIC AND FIRE <br /> Water Supply : 1 " DOMESTIC ❑ Surface Water (Attach Water Rights Information ) <br /> Domestic Wastewater Disposal : SEPTIC TANK <br /> Process Wastewater Discharge : Ponds : Applicable WDR : <br /> Storm Drainage System : DRAIN BASIN ON SITE <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day Gallons/Person/ Day Total Gallons/Day <br /> Domestic Water Usage by Employees/Customers : 4 50 200 <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 Day . <br /> PROPOSED WELL LOCATION <br /> Well Location Address : I City : <br /> Well Location APN : <br /> Well Latitude : Well Longitude : <br /> Flood Plain Designation : Well Elevation : <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth .&L IAcres 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) : <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 : 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 Stockton , California 95205 T 209 468 - 3420 F 209 464 - 0138 www . smcehd . com <br /> 1 of 2 <br />