Laserfiche WebLink
1@l10f26@0 08.11 209848B®98WESTERN RSSET PAGE 02 <br /> sea%of canon,* <br /> C."Mm"Wa at wow Ite"M9069 <br /> 32818 4lee"t <br /> Ba"MIMMO,CA e6ata.?pi7 <br /> i, OWNER'S'REQUEST F'0A WELL DRILLER'S REPORT(WELL LOQ <br /> Please use the back of this y <br /> must be provided before a Rage to sketch v the location Of your wry_ 'Ad ugt <br /> seam;for the w*U [qg C'ark p b trtfo�lion <br /> from► cross streets. Show Mndit'Nl*s such as schools,Deg€n. Give r atancea � dimWons <br /> county roads, main streets..etc. {indicate North an the eke pas <br /> offices, <br /> ` historic sties, w9l"Mays, <br /> Location of welt(City a.-f►d Cou • <br /> MY) . V e �['t�r n <br /> Street Address65- � <br /> " <br /> TownshipRange'. 36 <br /> �rZ .5 <br /> M-4 or Courts Planning thea a 'rrb•SeCto ru 1 114 or V4 1!4 Section <br /> rtw�i►be abrs!�f�rn[an this! tai) <br /> Assessor's Parcel Number ton tax statement 6� <br /> tergo"Ible,PI�'Itwha 7 a Cgs <br /> copy of t1..lsrsso�0 pw Mag,) <br /> -Subdivision at Tract <br /> E.at No Farcoi <br /> Owner when well was.dill d "�C c:i: �r <br /> Other Previous Owners <br /> Well Drilling Contractor or Company, W <br /> Year Drilled <br /> Depth of well(if kno")J1�(2i s.ar..i�1., Diameter& <br /> (This inkim9tlon h nes <br /> ecsary It�w Raw i mere than tYP4 of CaSir4� 6 `f .7 <br /> I <br /> Section 13752 of the CaGtornia Water Code <br /> upon the wrrlRen request of the0*rMf of the we The nwnetss certificationm st be coers Amp tenly <br /> ad <br /> t Certify that i am the Owner,of the won Please se <br /> de�bed above. . well d 3fins mCOPY Of ft'water <br /> jr <br /> Davi r rr � <br /> ' Ngfne � Q�l�7S�Q <br /> CortRp� C' <br /> �' 30�n52 <br /> - Edwards Roor-1 , ! <br /> Address '• ni ....mow,, 4(/� <br /> Addmils- <br /> rA <br /> 0A gra <br /> Car.Z51MO and 7Jp Code r <br /> City,Statff end Zip Code <br /> Teis�ona Murs�er ---�— 70 <br /> 'Telephone umber <br /> c)N 333- 930, <br /> nn. x1-14 "',27sY `i;v <br /> 1�•,L,. � Gv i ►.I 7 h <br />