GW1-2021-01676_Well Construction - GW1_20210429

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1 .Static seater Ieve1 below tap or easing.. (ft.) Dtvidoo of Water Reources,Information Preca ins Valk
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��,/ L ,y vt� above,also submit one copy..of this ,form wi0iht 30 dqs of completion of well
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the a ddxss(cs) above, also subinit one copy of this fowl within 30 days of
b.Disintiecdon types Auiotmr_ wmptetion of.Vdl consbuaena to the comtl)Health depalunew of the county
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