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Home My WebLink About1969-2269 - general permit s ^�.. " ,=h . ^t '4 A,xy �..,. - . �� : �... ri, � ._ .. �^�� n.:�. ... e � �.', .J'�� ,. . ..;y.- .r`.l<. � Villag� Ps�rmit N° 2 2 6 9 � rF.f. � `�� 1 , / �/� � ' Contractor �YG G�� v� �� Address L D � : ,' i c.f;�n��d � E � .��5 � s, G -r t�� ' � ' Ov��ner�—_ C- Address J y i �` ; � � � �State License No Village L,iccnse No ; � . : j` ,:: _ . ��T��.�� , � : �ILL.P�GE Or C�� flNO r - Crystal Bay, 14tinnesota , r �� ;' . �c� ` �>�� `:r`' , ` . Parcel No �' �„�. � � �� '" Seation No L,ot Blocx Su�ivision � �l '+�. ; . �--r t, ,��''"` 1�'- ` P18t N0 � ; . . - � �;;, 'Y �' ''"� Other Des�ription: � ,;r�. �� ,� _�; .� �� r ~ �i f , { �� . , � . '+;.� ..�, .�. ; .,�_. .. I',hereby agree that, in case a permit is granted, all work which shall be done and all materia]s �ti•�iich shall be used, shall r � .:ta�-.: cot�ply with the Village Code of Orono applicable theretq and �hall include all additiona] specifications as liste3 below. � =�_t �. •�� ,._.. Y {' ' , . .'4 ^ . .�' . ... ' _ �.., �I.� �.. �, �:' ' ' . '- 7 } � .- - .�!� 'T� J , . k�;� f . - � . , � �F �' � �.f F , ..� � . . &' .:J� 1�. � . . � � . . • t.,w � - f i f� � � , . . i � �� _ ' '/.♦� . . � . ' _ -4,� s� .. � - � :er_ . . . . . _ - - 1 t � . - �?' ` �Tnstall plumbing systems: Fee $ Signature of appl.icant , ,kr Install ,. -�, ` . ". !,.,� sewage dispossl systen�s: Fee $ ,�� . �'` �-Repair. � � �' � ? ; � lr�, � " � er supply systems: I'ee � I1`�` �J 0 Repa�r ' - Signature of �'i11a�G Of�ciat i; � ree $ � � 1 � Total„amount �paid to Village...... . $ �1�"� �� (` `�'v s= j � � .� y, .� �, ,. �� . . � , . :. .. ._ . _ . . _ I�j ' � ;s ��. .Y,� ; +t�- >:r 3�....+v"`'. '�' ."sr ^� s: ' EP;X :_ � �c 4rr �,� I �"'4`-, "l� � a�"�i $'�.�.r� � ;..,�.�#s �t. _ ,. - .�i?F', aY� „n�'�., NF'.. rk.t, ;'j �� 'y } �' ,�. . � Y �.f � . . . - . . . - . ' . � . . � . . �-Y. . . • �$_ ' . . . .. � . �. , -� WELL OWN£R AND ADDR569 . a. � � � '` WELL RKORD ',� Y .i.:..i �� J r ' _'/� �/ - � ..�i � wE�CATION secTiL o�� J �or v eWGK � VIL!AGE OF ORONO , . � I � CRYSTAL B.+.Y. MINN. �� . .j DRI!LER'8 91CNATURE DATE rER6ilT NUMS�R � �� i � , �� .; 1�_ -z-�'.=��__ . , DRILUNG CO. ANY ADDR�93 TELEPMO`IE . . . . Z,��. � � �'�/f/ �f� � _iC�� .�� i" �J� �. �9 , I j ( � �� . ' f SiZE OF WELL �.i _INCHtS WATER �EYEL---��-----REtr ' i � • .'� WELL dEPTH----1.J�_ _F�S'l' DRAW �OWN-_--_---FEET AT---GPM '. � , � _ . : ' `{ CASING DE?7H—�_�9 __—FEET CAPACfTY GALLONS�"��.--f'ER/HR. I �. . j DE?TH OF (MPERYIOUS FO�M!\710N. _�� L�-� CASED WITH � ' , ^ , � ++ � WEI.DED JO!NT n t � i SCREEP: � FEET--__INCHES/HY "�__ItiCHES - R •`� MA}tE AND TYPE M.4TEP.(AL: T�' � ,f� SCRE4VED JOINT�/ � 'Y • � �„AC//u� . .. REMAR?:5� . - i - . . (OYCR) � .. • . • •• . • . ,. .. • ',','� �, . • .. . t .. . __. ' ._..�—'__�. ' . /��5 .. , ' . . , . ' � . .___. .._ ._ . .. . . _ �__ __ _.__._. .._ .�� . . . . . � . ' :{. � . ' �1 r '..� .. . '. . .. � . . � . ,;� �:. . .. ."'". . . . ,. . . _""_'.' "'_'_'�.� _ . .. ... _ . ._._.._ __ � . ' . ' . - . . �^ � '— TMICK�tifs f BTARTEO =NDED 6► � . . KIND OP FORMATION CJLOR I DEPTH DErTH ronw�T�o� RELAARKA , �� - },1 y �. , �G•S� i%i` t • • t ... • ,_ . ... • _�f �, a . .. P� • .t t' - ( .. � . '_•�, ' ..+� . . � � . ; -ti ' , .�t � ' . . _ . . ` y 4 '. -. '!�..SS. ' �. -�:• � . :•S: --'.}.;...: • . .� _ . . nf . . . � .�, . � ' �' [XTERIOR 6PACE AROVND CA51N6 SEALEO WITM: � CFMENT (iROUT � PUD'uIED CL.\Y � OTHER � ;;"t-� DISINFECTANT UBED .-1� ' � � i�•'�. HOURB LEFT IN WEL� ��1 � (OYEP.) ;�^� S"�'� ';'�C'-0'�w,��4�riTrF3:.�rraar%�67.tawo.a.u. - -- �-- .—__.__ .- ---..._____.,. __ ..._.. _. ---. .__._ _._._._._.�.__._. ._...�___ ..� �� .r `-� -. ' . .. . _ . .. .._, ...,,,,..�.,. � ' '" Y . .� t �( 1 : "` �' ;. L•... � . . . f.y*r-�....,+f n+e `� _ i `1 �., . -, . : �,> . '� �! � .,643�8$«2!i.$.4Th4,�.�f�+�.�dD.iri2�a�i#L�L��Hn' k.."'!M ' -«e...�...�___�_ _ . ._._ . .. _ . . ._ . . ,..... s. .. ... �; ....�: �.... .