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.. SA�a,� �QpU � la Errovironm�rn4..�.. S-9ca9Y.9i �epartmE:rxt <br /> - ` ...__.__COUNTY..__..__ <br /> Water Usage Information <br /> ;; ,;,. 'PRO CT.%INFORMATION "+ <br /> lication Number: A licatlon T e: 5� Hi <br /> Pro act Address: Gu- Gif N _ Pro'ect APN: S�:s= - 2/ (- <br /> licant Name' s'4i Title: G'o,.� <br /> licant Address: - C3 n CI /Zi 5 Z/ <br /> licant Phone: �- Email: 2 <br /> Pro ert Owner Nam¢: �!) w (- � <br /> Pro ert Owner Address: '- v G✓. !f/ /Z Ci /Zi 2 Z <br /> Pro er Owner Phone: — - Email: CGY�. <br /> >"�SERS/IDE5 INFORMATION + . • .t.r ���=2: +�vr `.�^ <br /> Please rovitle Jason Hon below: <br /> Water Supply: ��� �l� - O Surtace Water(Attach Water Rights Information) <br /> Domestic Wastewater Dis osal: i <br /> Process Wastewater Dischar e: Ponds: licable WOR: <br /> Storm Draina a S stem: � � ":'i'r'k <br /> �•�. '-'"° `4VATER.'BC:GE DATA •""-- <br /> Provide for tote/water use eat/u//buildout umber Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usa e b Em to ees/Customers: <br /> T bf Process/Irri ated Lands Total Gallons/Da <br /> Process Water Usa e: / <br /> Process Water Usa e: <br /> Irri anon Water Usa e: <br /> Total Galldns Per Da <br /> ' '- - -P ROPOS.ED ELC LOCATION :--. �- <br /> Well Location Address: Cit <br /> Well Location APN: <br /> Well Latitude: Well Lon itutla: <br /> Flood Plain Desi nation: Wall Elevation: <br /> 'PROPOSED WELLINFORMATION:. �� <br /> Well Total De th It Acres to ba Served b Well: <br /> Use of Well: o Domestic o Irrigation o Small Public Wa[ar Supply O Municipal Public Walar Supply O Induatdal O Stock <br /> o Other: <br /> De th of Corcoran Cla ft <br /> Pro osad Wall Ca acit al/R: Estimated Pum i Ra[e slhnin <br /> Amici aced Pum in Schedule al/da Estimated Annual Extraction Volume a a-feet <br /> Estimated Cumulative Extraction Volume before Janua 1,2020 acro-feat <br /> ' -SITING'INFORMP_.TION f A'':' "�•i . <br /> Drs[anceTO Near¢stff Onsite: Offsite: Distance To Nearest ft: Onsit¢: Offsite: <br /> Wastewater Treatment S stem: Jt�//�C- Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: ry S[reaMRivar. <br /> Animal or Fowl Enclosure: N/T Navi able Watervua <br /> Storm Draina e S tem: Potantlal Rechar a Features: <br /> '.: r ,•. ':is ,. v _ , .;.i ..r -'!z`::GROUNDWP.TERINFORMATION>' <br /> De th ft: Source/Date of Referent¢: Groundwater Subbasin: <br /> Current Depth to Water: N/s D Cosumnes Subbasin(2-22.'16) <br /> N19hast Depth to Water: O Eastern San Joaquin Subbasin(5-22.01) <br /> Lowes[Daplh to Water. O Tracy Subbasin(5-22.15) <br /> 1868 E.. Hazelton Avenue I Stockton, CaliTornta 95208 I T 209 468-3420 I F 209 464-0138 I www.elCand.com <br /> t of 2 <br />