Laserfiche WebLink
TY?E OR PRINT IN °_LACK INK. APPLICATION MUST BE COMPLETED BEFORE ACCEPTANCE. <br />A= PI.ICATION FOR : <br />_ _ A P~~iT TO USE GROUND Fi.~.T~2 <br />_ _ A PINS~ffT TO CGNSTRUCT A WE'iS, <br />REPLAC'2~'ffTIT FOR N0. <br />A PERrffT TO INSTALL A FUMP <br />OTP_R <br />:i~PLICANT ~ ffcy'N~' ~/ e- . ~f1 l..D V~/ 1 /l <br />Street Address ~p.deWy{,~, I J~i}2/} <br />,City&State we5~"b-~~o~oQpDa81091 <br />:Telephone No. <br />NAME OF AQUIFER GROUND WATER IS TO BE OBTAINED <br />FRaM: Sri ~ ~d~ A/u ~~ u / <br />PROPOSED TOTAL DEPTH OF WELL ~Q Ft. <br />:~TIMAT'ID MAXIMUM PUMPING RATE /~ GPM <br />;.•FERAGE ANNUAL AMOUPdT OF GROUND WATER TO BE <br />APPROPRIATID ~ Acre-feet <br />P3ITICIPATID GROUT PROGRAM <br />Iwals /O F~e1T o` S~(Y~FdGe <br />Placement Method rT dy,.J <br />PROPOSID CASING: <br />Plain _L in. from O ft. to SLO ft. <br />in. from ft. to ft. <br />Perf. ~_ in. from _~[~ ft. to ~ ft. <br />in. from ft. to ft. <br />GROUND WATER TO BE USID FOR: <br />~ DOMESTIC (1) - <br />LIVESTOCK (2) <br />MUNICIPAL (8) -_ <br />OTHER <br />y ~ <br />coru~RClaL <br />IrIDUSTRL4L <br />T~2RIGATION <br />~~M <br />~_ <br />~: <br />r. r, 8.. <br />~~-. <br />W=~~ <br />s <br />3 '0 <br />(4) <br />(5) <br />(~) <br />WELL LOCATION <br />XCOUNTY ~05 ~i~.mas <br />Jc~_ u of the /f/y/ 4 of~Section 30 <br />XT. 33 R. lo~ ,C,~ ,tJ ~o P.hI. <br />IIQ ADDITION TO THE ABOVE, THE WELL MUST BE <br />LOCATID WITH REFERINCE TO GOVERNMEN'P SURVEY <br />CORNERS, MONUMENTS OR SECTION LINES BY DISTANC: <br />AND BEARING (DOMESTIC WELLS MAY BE LOCATID BY <br />LOT, BLOCK, & SUBDIVISION.) <br />ft. from - section lir- <br />North or South <br />ft. from section li-- <br />East or West <br />XLGT o2 ~ BLOC1~K FILING #' ~,(o P~- <br />1~SUBDIVZSION S/m~~c./o// ~~~, <br />Ground Water Basin !(iNkiye~~i <br />Water Mgmnt. Dist, t{,vx./d vn/ <br />Anticipated drilling date 3 - „? D 19 <br />Owner of land on which well <br />is located: <br />/~ DR ~r~ e. ~ ~r~n ,v; r~ <br />Other water rights on this land <br />Driller L/ I SiYM d e H No. ~1- ~ ~(~'ic.,~.~..wL 1, . [r~C,.n.~ _ / <br />,p_~ ignature of Applicant <br />4ddress ~Q E/o J( S,j, /Y~/.v i c1 d d. ~o ~, g~~~~ <br />IF WELL IS USID FOR IRRIGATION. BFLCK SIDE OF THIS APPLICATION MUST BE COMPLETID. `J /~ ~~ <br />APPLICATION APPROVID: VALID FOR ONE (1) YEAR <br />AFTER DATE ISSUID UNLESS EXTENDID FOR GOOD <br />CAUSE SHOWN TO THE ISSUING AGENCY. <br />PERhIIT No. 53229 <br />• <br />DATE ISSUID MAR 1 61972 <br />... <br />~~ ~ ,~~ <br />STATE ENGI ~ p <br />BY ~' ~ <br />