Laserfiche WebLink
WELL SURVEY QUESTIONNAIRE <br /> Dear Occupant: Date: <br /> The following is anindependent survey regarding the location and number of water supply wells in <br /> your neighborhood. Please complete the following questionnaire. Should you have any questions, <br /> please contact ETIC Engineering, ,Project Manager,at <br /> 925-6024710. Thank you for your cooperation. <br /> 1) Owner name: Phone#: <br /> Address: <br /> 2) Occupant name(if other than owner): Phone#: <br /> Address: <br /> 3) Is there a water supply well(s)on the property? (circle one) Yes No Unknown <br /> If so,how many? (number): <br /> 4) What is the current status of the well(s)?: (circle one) In use Not in use <br /> 5) What is the water currently used for? (circle as many as apply) <br /> Drinking water Other household use Landscape4rrigadon Monitoring <br /> 6) Is there a basement on the property? (circle one) Yes No <br /> 7) Is there a sump in the basement? (circle one) Yes No <br /> Please remit to ETIC Engineering within 3 working days of receipt of the questionnaire. Thank you. <br />