HomeMy WebLinkAbout1972 - 3338 - general permit 3x38 ; 4
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Village Permit ,
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State License No. — Village License No. .Q
ERAL PERMIT
GEN 11
VILLAGE OF ORONO _ ;
Crystal Bay, Minnesota . 1
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s Date ` r' i_ -71-'
r'' Parcel No.
' Section No Lot Block Subdivision f
Plat No — ,
Other Description: �Y
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I herebyagree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall
comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. � �
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Install plumbing systems: Fee $___ Signature of applicant
-1' Install
sewage disposal systems: Fee $
-Repair
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J! Install
water supply systems: Fee $_f( ' n -�Repair Signature of Village Official
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Total amount paid to Village $ ;/ '("' • S( p
Village Permit NO 1 01 +,
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Contractor S/ ti A W E I- L C ° •ddrest A /r 7 rj
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State License No — Village License No_ / eFfG
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GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Section No .I Parcel No.316° L044';? Block__ Subdivision F° 1- t: ` T I- A k F /J/` rR
Other Description: •
I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall comply with
the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. -
Install plumbing systems: Fee $
Install sewage disposal systems: Fee $
Install water supply Y 1 systems: Fee $ co
Fee $
Total amount paid to Village $ H
Signature of applicant Signature of Village Official
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W?�.+ WELL OWNER AND ADDRESS `'
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a ✓ WELL RECORD
! ^--- '- t C t — 3`G� ' — VILLAGE OF ORONO
WELL LOCATION SECTION LOT BLOCK
CRYSTAL BAY. MINN. t
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DRILLER'S SIGNATURE 1 DATE c PERMIT NUMBER >
,4. TELEPHONE t
� .. DRILLI COMPANY ADDRESS
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'4' SIZE OF WELL ` INCHES WATER LEVEL J 7 FEET
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�} WELL DEPTH //� FEET DRAW DOWN 1/h�=FEET AT GPM
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v:. ; CASING DEPTH /Q FEET CAPACITY GALLONSr�y60 PER/HR.
CASED WITH
n,r DEPTH OF IMPER IOUS FORMATION FEET
Vt. L� WELDED JOINT ❑
+?•` SCREEN JS " FEET 7 INCHES/BYn 7 INCHES
,. � � ��/ SCREWED JOINT
MAKE AND TYPE MATERIAL:
1:1", REMARKS:
(OVER) •
. '`.yrs
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t . THICNNEss ,
STARTED ENDED OF
;.';,• KIND OF FORMATION COLOR DEPTH DEPTH FORMATION REMARKS
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F' EXTERIOR SPACE AROUND CASING SEALED WITH; 0 CEMENT GROUT 0 PUDDLED CLAY 0 OTHER
, •" DISINFECTANT USED i ! `
t_ HOURS LEFT IN WELL
(OVER)
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