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V" Wnh STCALIFORNIA - yO RO
<br /> THE
<br /> gYu(R Y8t>�i<
<br /> E RESES OUU RCES AGENCY n
<br /> toc� ijRtlPa1�11M DEPARTMENT OF WATER RESOURCES NO. 227041 tY+
<br /> A
<br /> A
<br /> "ndre at hent N.._'_ WATER WELL DRILLERS REPORT
<br /> U.1 Permit No.or Drrtr Sante\Vrll Nn -
<br /> ()nherWellNo
<br /> (1) OWNER: N,n,e A.,y at,rt t (12) WELL LOC 42b 42&n,.,:,wr
<br /> CC T : t do Iov lh f ,l,, I -
<br /> idN Jia Immo (I er fr. F-n, p flhltnIM by d�lnq ehnrue r, be m.t d l)
<br /> blty As i n to 4A 7 i f _Zip P L
<br /> ,(2) LOCATIONOF WELL (Sec instructions): ! 1,-,,lY .
<br /> oanv Owner'.Well Number 2 1 S g cks
<br /> dlfferen,f,,o,, it- ?2 gown '1.x
<br /> Tnam.hpr RAnee Senmo ^_—.— c tit) > tndl 'cr rY 1.,u .7
<br /> Di e.nre rmm ane d..rnum.a.,fent,.,ne 4/9 Y1pr, tr n,y 6 eu,�'n ^ ta•
<br /> I C .t -----L
<br /> IJ
<br /> c
<br /> (3) TYPE OF WORAr r i '+:: I�fr- . �s r
<br /> (� Well DeepenlnK❑ � l
<br /> �.,-: Rrenmtruct nn ❑ 13Z t -
<br /> ` v ��
<br /> Reoomfltimlo, ❑ \•.. �tji i ISJS is YV"--
<br /> \l\ /
<br /> find, ml Well ❑ Atea-v �[T'L�"fiP.'3
<br /> �.\ ✓ �`..�.-�. d t nnnm lamb n D+mdum I Item,327C¢' ... – �� .,n . �✓/`✓�
<br /> (4) PROPOSED
<br /> ❑ \\ x
<br /> r y
<br /> W'EI1 LOCATION SKETC1l `\ O[I er ❑ '27g � '� �I..S.V ._ %^
<br /> (5) EaVIPMENT: _ (8) CAAV$I,SACK V"\ F
<br /> rl ¢v
<br /> 1 Ruf.� ❑ n .en, p �, ❑ No px v:e.. i 72 _172 \ tri °)(
<br /> cable ❑'� A, ❑ \ DI �><rof boor
<br /> \ 416 13L_:-
<br /> a6n: ❑
<br /> Bucket a PAr.l t> t ) R. ,\\\4-_fr ..424 bvirtie nlav _
<br /> 17) LA.,ZLG INSTALLEDt -(8).PERFORATIONS,
<br /> �. .. ( \ \ -- t y4 42,F- a.a rid RnA avAL
<br /> isn't(N PI do ❑ conm'tae TYW of'o nh' ( n -
<br /> o f t}Ic q oaT Fnfi*� iT. /
<br /> ft
<br /> Tv nn wall ft'';\� it. / \(Si,fo. r`
<br /> e ❑ �(� - —
<br /> j,,(9)fWELL
<br /> SEAL; � � y
<br /> 1tS.+W1i�3 YYr tt.vnitaN Ip wdeai Yes 'R)h No f' If t ---
<br /> � "IM mt'poliu<ont Ye. ❑ No [}�.IrtervuL___Jf �
<br /> F 5'dei6odd'd'-ntne •e C(>•y ,
<br /> I ,x'(10) WATF.A
<br /> LEVELS: P.F.LL DA[LLL'A'S STATEMENT:. . .
<br /> ft rhi, It a dellfM wdu mV hWrdlrtlnn end fh4eno,t rn.. t t the Mn
<br /> 5landl R I 1 ever U romptrNo 147 ' ft knewbdue r d belld. ' o)n y
<br /> •�"—
<br /> 'I 'W., all tw "'de, Yo U N EX If.vr., h, whom? � (Well D'liw --
<br /> Type f but Pump C Reil, ❑ Air lift❑
<br /> NAME +nr o dai l vrlt Li Jnr _
<br /> DepW t W.1, nr. At end of t t__h
<br /> (P.m.,arm..1 rorpomtt ) (TYPa1 or printed)
<br /> D Re_ —std/ ate. ,p "- Wal r mn turv. Addre, _
<br /> Lo z1ii. 953(]
<br /> Cha ( I 1>.h m 1 7 Y C 1 ❑ If >n by-h..'-- City U 1 dA Zfp
<br /> Wu electde Ing m.det Ya U N. ❑ If vas, nttnrh � \ / /bt
<br /> ram In thi. �epom urm. N,_�+Lf' Dae nr this mpnrt L LC___
<br /> DWR 188 f,,.,vaet 1F ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
<br />
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