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WP0042150
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ESCALON BELLOTA
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12569
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042150
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Last modified
11/22/2021 2:55:52 PM
Creation date
9/14/2021 2:49:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042150
PE
4373
STREET_NUMBER
12569
Direction
S
STREET_NAME
ESCALON BELLOTA
STREET_TYPE
RD
City
ESCALON
Zip
95320-
APN
20719032
ENTERED_DATE
6/14/2021 12:00:00 AM
SITE_LOCATION
12569 S ESCALON BELLOTA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
Tags
EHD - Public
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Bolt'ehole Spe"cifications 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 HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 09/14/2021 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> f°F" DW VS rOn'Y s ai <br /> CSG# State Well Number Site Code Local Well Number <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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