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WP0041303
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041303
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Entry Properties
Last modified
3/11/2021 12:17:56 PM
Creation date
12/10/2020 3:47:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041303
PE
4368
STREET_NUMBER
17710
Direction
E
STREET_NAME
CEDAR
STREET_TYPE
LN
City
RIPON
Zip
95366-
APN
24514006
ENTERED_DATE
10/5/2020 12:00:00 AM
SITE_LOCATION
17710 E CEDAR LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
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EHD - Public
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Borehole Specifications Certification Statement <br /> Depth from I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> Surface Borehole Diameter(inches) Name MASELLIS DRILLING INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State <br /> Signed electronic signature received 10/26/2020 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> Image_01675.pdf-Permit CSG# State Well Number Site Code Local Well Number <br /> 17710 E Cedar Ln Ripon.pdf-Location Map <br /> N W <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />
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