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HomeMy WebLinkAboutWELL-07-2015-062579.TIF Mar. 21 . 2016 01 : 10 PM DOUG KEEVER 7049661175 PAGE. 2/ tin (465- n,b Ica Y ^�-i D fin7V7WL CN5CUGIORKCO Now, a 'm Dews ezav amanandNa aRswim-D» ndiWan Q *y " WELL CONTRACTOR CERTIFICATION 0 t. ORSI/.4GTTC1t T" °. r Amount Lro z 1.WILL CONTRACTOR: 61` C. y WATER ZONES t Rota45 Tq Gb O Fran T4.____ wet Contactor(Mdhamd)Ntma Pro 1(0.5 non To Fmn To L 4Ka.-1 470/AeA� l.7 To FromTo _� Rao I T nano/ STREET ADDRESS- Eo$3 o O 0IQ�••a C. Q CASINO: Dl . WeLFn Lw S(k rn,l I rrora 4\c- 2�!o 3 Rea A0 To__Ft _____ Fir Ta Ft__„_._ caya Town Stem �GOOe From To Ft 70 1-( r Lit3 >- iiisamr w ciioi:t 7. GROW: DNS fAevial MORA 2.WELLWFORMATM?et Frtna_Tu 3C F), Po r 4bAa TS.LOu� SITE w6LID?or ) an 15 OL. 1S7 9 Rp„ _ To R Lam_To PR STATE WELL POUN E R mobs* DINO or on PEKOE ME RAloede) E. SCE: DNS OWNS SLa Sr Mesita Fag---Tti Ft---in- __et -- FALL USE(Chool oPR' wlga- FN O �_To FL_..... 10 _.k. —__ PATE DRILLED D D a I a 1 l Fmn To F1,�,1n TOME COMPLETED_ S AM Q PM D"-- S. SAlaacRAVEL PAQI: DoMb St.A LMapld A W61 LOCATION: FT= To R. mom,pre: 5harnhl9 Fomom, c.t..)6q — Rem To Ft 7 a 2.1 c-o c ICc. O r ? c i 3 F1mmTo Ft____ — *es Na CesonS beetheor tot NO-0000.El)cooN I LARD SETTDC so.DAWNS LOG d Ore ORS Opp From To Fomwffon Date+ n %tact worms bad LATTTIJDE alswcaseootma 3 d Q rev r LONGSI11DE L b I L°4 Se3 IeaeeekW ens - 70 C..o•A) ' I bngim8e antnor COS Vropogrophic map Sadb rt duel toast 0e Soon AUSES tiro map ard eadlW to r*itrmi not raft . 1 yx.o.r tOrgtO I.e I Q0 4.WELL OS MER . STREET ADDRESS "721 4eeke Or $07 .5k 'r1I 15 ray, /tee n4'}y3 — CRy or Ton Slam a code Ana Dodo- Mow t amr 11. REMARKS: L WSJ.OCTAL& �1 • PT► a TOTAL DEt 3 /•5 b. Does WELL REPLACE LD09Th WB1T YES T] no e a WATER WM.I loor Top d 4a FT. C TM4 WAf.:all Ma0oe OINCEWlm 7C. /a1osove NU4NT400P/OF TM Nso'�'EAtowTtgdCaiyl RfiCPOMS:te9lfmTUSWev.w.rdc f d TOP OF____m I. 6 FT.A4tlws M Surfs:i y�a.,�lb lop d away hamYaR.o actor 11M�Lend ew/eoemeL•roads sLm+ i o�wo1.cdNTRAC110R a4 a%taceln a^s-daloeW i 15A NCAC 7C DM 11 A Y13.0 dray a MEDICO OF TEST Pr.abol< < 5 �G NAeE OF 1