R-6845
(Domestic Water Supplies, Form A2, Munici
~orporation or Civil Subdivision)
STATE OF CALIFORNIA
DEPARTMENT OF HEALTH
RESOLUTION NO. 6845(CCS)
Certified Copy of Resolution
(To accompany application on Form AI)
"Resolved by the~m n~~ ~~t:Ym~~~~\1~~~~~~~~~~~~~mnn_____m~~~_______nn ______~~_ ._~ .~~~m~_~____.. m_~_~
(City council, board of trustees or other governing body)
of then~~~~~_m~~mm~~~~~~_..___g_~~~~Y___~2_~n_?~~:t~m~g_~_t<::~___._ ~~_______._n..____
(City, town or county, etc.)
that pursuant and subject to all of the terms, conditions and provisions of Division 5, Part 1, Chapter 7, Sections
4010 to 4035 of the California Health and Safety Code and all amendments thereto, relating to domestic water
supplies, application by thiLnm__~~~~~~~Y~~~mm ~ ~ . be made to the State Department of Health, for a permit to
( City, town or county, etc.)
Drill, equip and utilize for Municipal ~ater supply, a water well
Applicant must state specifically what is being applied for-whether to construct new works, to use existing works, to make alterations or additions in
designated Charnock Number 18.
works or sources and state nature of improvement in works. Enumerate definitely source or sources of supply, kind of works used or considered (if known)
and specify the locality to be served. Additional sheets may be attached.
that the__~_~.~_~~~g_.U:Y___~_~_:Q_~_g~~_____~____~________________m_J_Q_ r 1SfCsaid_____~_~_~y~~~.<2~Q~~).~m_~.....____________~~~~____.._ ____________
(Title of chief executive officer) (City council, board of trustees or other governing body)
be and he is hereby authorized and directed to cause the necessary data to be prepared, and investigations to be
made, and in the name of said_m_m_________ _m_~_~~!:y~_~___m_~~_~~_~___ to sign and file such application with the
(City, town Or county, etc.)
said State Department of Health.
Passed and adopted at a regular meeting of them_ Ci ty- _CQJ.mcil. n.___.___
(Governing body)
of the______g~i_:t:y.__g~~~__?_~~T.1~!:~_..~!iQ_:Q_~_~_~____~~
(City, town or county, etc.)
nOn the__
27th
m~~ day oL___mM(lJ,:~<::_l"!__~~_~~~m___ _ , 19_~~~.4.
[
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OFFICIAL SEAL
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Clerk of Said
ma0:1n?J1_~~/~~~~~
Ann M. Shore, City Clerk
City of Santa Monica
(City, town or county, etc.)
EH 101 (10.73)
~PPROVED AS TO fORM
~_:::::_=_~o ,i:1N'.. CD osp
(Domestic 'Vater Supplies, Form AI, Munid
-;orporation or Civil Subdivision)
STATE OF CALIFORNIA
.
DEPARTMENT OF HEALTH
organized un deL_
__ _____n__c:_~_!:Xmc:>~n_e_~_~_!:_~__~_~~~_~_~_____________m____m____________m______
(Name of municipality or civil subdivision)
Charter, November 5, 1946
Application from__
(State whether special charter or under general law, giving class and date of incorporation)
To the State Department of Health
2151 Berkeley Way
Berkeley, California 94704
Pursuant and subject to all of the terms, conditions and provisions of Division 5, Part 1, Chapter 7, Sections
4010 to 403,5 of the California Health and Safety Code and all amendments thereto, relating to domestic water
supplies, application is hereby made to said State Department of Health for a permit to muQx::il_l-#____e_CJuiJ;L_
~!:l_?: __ _l.!:!:!:_ ~ ~ _~_~ __J ~!;_ __~_l.!:~_tS:!:.P. ?:_~___~_~!:~E___~_~p.p.1Y_L__~__~~~t~~_ _~~_l1___<?:~_:?Jg_~~_t~g_ _______n_____n.
Applicant must state specifically what is being applied for-whether to construct new works, to use existing works, to make alterations or additions in
Charnock Number 18.
works or sources and state nature of improvement in works. Enumerate definitely source or sources of supply, kind of works used or considered (if known)
and specify the locality to be served. Additional sheets may be attached.
March 27 84
Dated_n_nm__mm_____________, 19_______
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OFFICIAL SEAL
HERE
]
City of Santa Monica
Att"'22
____________?z~~l.__Jl:2l~_.__:d_:.~L"__
(Name of municipality or civil subdivision, in full)
BY..~~~fu.............
official title and post office address)
_ ___8:I2_E~_<2_Y"~_9:__9:~_m!:g___J~~_~m__
(Signature of clerk or corresponding official
.....&4...=h~~")......._..... ....N=...~~~.~
Before making application for permit, such action must be authorized by resolution of the governing board, substantially in the
form furnished by the State Department of Health (Domestic Water Supplies, Form A2) and a copy of such resolution, duly
certified by the clerk of such board, must accompany the application.
EH 100 (lo.n!)
tB9Bt.4150 11.73 5M <D OSP
ADOPTED AND APPROVED THIS
27th
DAY
OF
March
, 1 984 .
ABSTAIN:
COUNCILMEMBERS: None
~
MAYOR
I HEREBY CERTIFY THAT THE FOREGOING RESOLUTION
NO. 6845(CCS)~WAS DULY ADOPTED BY THE CITY COUNCIL OF THE
CITY OF SANTA MONICA AT A MEETING THEREOF HELD ON
March 27 , 1984 BY THE FOLLOWING COUNCIL VOTE:
AYES: COUNCILMEMBERS: Conn, Epstein, Jennings, Press,
Reed, Zane and Mayor Edwards
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
ATTEST:
a C"!:,, II.. /
y'./'7'~ I'~ / 1(,41:j,~cr_
CITY CLERK