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PRE 2010 DOCS0 BUILDING PERMIT 0 Village of Fridley, Minn. N° 2906 Date1' .3 �,..!� ..... ....... . Owner`.i.. .. ........ Builder ........ ....................... Address ..� (v l�..... ................. Address ..... .l�.l..... ....... LOCATION OF BUILDING No. ..1. (0. 9.9 -. ..... Street ....................................... Part of Lo ./10 697.Jxpr V. lr Lot ................ Block ... 4r......... Addition or Sub -Division Corner Lot ............ Inside Lot . SL .... Setback . 3�.�.... Sideyard ....... o b Used ... DESCRIPTION OF BUILDING 4� , Front .. a .. Depth .'i ... Height ......... Sq. Ft. 10.... Cu. Ft........ . .................... pFrront ........ Depth ........ Height ......... Sq. Ft.........eelncl 'Cu. Ft. ........ Type of Construction . l . lti r . Est. Cost ... to?, a�0........... To be Completed ......... In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. .... .. .. ...� ..... ........... In copsider on of the payment of a fee of $.1Z% f, permit D hereby granted to .. .................... . � ' . ...... to construct the building or addition as described above. Thi ermit is granted upon the expres ndition that the person to whom it is granted agents, employees and workmen, in all work done in, around and upon said building, or any part ther shall co orm in all respects to the ordinances of Fridley, Minnesota regarding location, construction, al ation, maint anc , rpjarAmoyJng of buildings with- in the village limits and this permit may be revoked t any time up vi a o e provisions of said ordinances. ! w n NOTICE: This permit does not cover the construction, Installation or alteratio o iring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate per s for these items. 0 0 City of Fridley, Minn. BUILDING PERMIT N® 3398 Date: ....... . J..... .......... Owner Builder ....:.....\ ................................ . .... ..... .. ..... Address ....��... ..... ... ..... Address ............................................. 40r.7r% tAcd pf N S007H -7 0-T— C t0 � q Vy. LOCATION OF BUILDING �. ... Street ......... �!+ V'X7— .............. Part of ... ........................... >......... Block ...84.01 ..... Addition or Sub -Division .. ���............. ter Lot ............ Inside Lot—X....... Setback ............ Sideyard ..................:........ DESCRIPTION OF BUILDING To be Used as: , ., 0 o2�Cm ...... Front . �5�.`.� Depth `'� ' ®Height /On / sq. Ft Cu. F't. 3,S' .................... Front ........ Depth ........ Height ...... Sq. Ft. ........ Cu. Ft. ....... Type of Construction ,�?QA!'.I:�� ..... Bet. cost. I ®® . ........... To be Completed ..............:.... `pr ty In considerstnof the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. t5— 7 In consideration of the payment of a fee of $. ..., permit Is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, paintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. • • City of Fridley, Minn. BUILDING PERMIT Date: July 23, 1965 Owner: SNOWBRICK Builder Address Address PETERSON IKP. LOCATION OF BUILDING No. 5649 Street 5TH STREET N. E. Part of Lot Lot _ Block Addition or Sub -Division Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation N° 8260 DESCRIPTION OF BUILDING To be Used as: Front — Depth Height Sq. Ft. Com. Ft. Front Depth Height Sq. Ft. -CUL - Type of Construction Est. Cost _ g9400100 To be Completed REPAIRS - STORM DAMAGE Urban Renewal Area - Referred to H & RAL by city manager on 7-21-65 In consideration of the issuance to me of a permit to c the building described above I agree to the proposed work in accordance with the description above set f in 1 /. I Dnp "th i% provisions ordinances of the city of Fridley. In consideration of the payment of a fee of E 10'00 , permit is hereby ranted to SNOWBRICK to construct the building or addition as described above. This permit is granted upon the eLp ess condition that the person to whom it is granted and his agents, employees and workmen, in all work don,FriHiinnesota regawitordces. ALLEN G. GENSEN NOTICE: Ub peeb den not emu the comtroeflm, hudalhfion for wbk& plumbing, gn hot&& awa w water. Be sun to »� the Building Wpedw for aparde pwmbs for than (term. APPLICATION FOR BUILDING PERMIT 'CITY OF FRIDLEY, MINNESOTA - BUILDER 4.4e2 OWNER'S NAME ADDRESS ADDRESS LOCATION OF BUILDING. NOO STREET J' Xi 1 PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT! INSIDE LOT SETBACK SIDE -YARD SEWER ELEVATION' FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used' I lli-t U 44 Dept Height Sq. Ft. 1: Cu. Ft. Front Depth h Height Sq. Ft. --Cu. Ft Type of Construction Estimated Cost4 To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do,all work'in strict accordance with the City of FridleyOrdinancesand rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct, DATE S M—Z ATURE �4�-, (Schedule of Fee Costs can be found on t e 'Reverse S • 0 City of Fridley, Minn.. BUILDING PERMIT Date: August 9, 1965 ALVIN L. 6CHNOBRICH Owner: Builder Address 5649 - 5th Street N. E. Address Fridley, Minnesota No. 5649 Street Lot _ Block JOE MOEN N° 8333 ,?re--?� Columbia Heights LOCATION OF BUILDING 5TH STREET N. E. part of Lot Corner Lot _ Inside Lot Sewer Elevation To be Used as: Front Front Type of Construction Addition or Sub -Division — Setback _ Sideyard Foundation Elevation DESCRIPTION OF BUILDING Depth Height Sq. Ft. Cu. Ft Depth Height Sq. Ft. Cu. Ft. ___. Est. Cost _ 1 100.00 To be Completed Repairs - Due to storm damage In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set forth and in compliance with aft provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to JOE MOEN to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in an respects to the ordinances of Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings ordinances. the city limits a permit may be revoked at any time upon violation of any of the provisions of said ALLEN G. JENSEN Building Inspector NOTICEt M pem b dos sof oawr the contra "", leatal dlon for Whk& phMblag, an hating, sewer or water. Be are to as the BuBdwe Kanter for separate pemdta for Elise Nemo. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER ' S BUILDER ADDRESS r�" /� ADDRESS 4 LOCATION OF BUILDING. N0. STREET . a" w, 7 , N., � : 'PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT V SETBACK SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION. Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. •DESCRIPTION OF BUILDING To be used as; Front Depth Height Sq. Ft. Cu. Ft. Front Dept_Height h'oa-JJSP,. Ft. Cu.. -Ft. �1� 6 A9 �'' •di !`�.p Type of Construction ,gig; �,� Estimated Cost elle'), 6=v To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE- ` SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** 9.,/4,V APPLICATION FOR PLUMBING AND GAS FITTHIIZ PERMIT M RK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR £3ath Wash Ertnk . Floor C>tcM Auto. Urinal Tub _.,. Sh wer Smk Tray Fount Drain Basrn Washer Effective On March 1, 1996 ---yJ, r Z Gas RAisG Water Heater Range Fixt ... Gas Elec SCHNOBRICH AL 5549 5TH STREET NORTHEAST NO. RAE TOTAL JOB ADDRESS_ HR I DL X475 W 780 55 Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ .00 $ .00 $ .00 $ .00 $ .00 $ .00 $ .00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ C) - bo The undersigned hereby makes application for a perm it for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. i y�S 19 Owner - NORKOM PLUMBING IMBING .+.. ® Sao (612) 827-4033 lu ; 03 Building Used As0z _990.5 GARFIELD AVE. * MINNEAPOLIS MN �5�4 "a� Estimated Cost PERMIT AIO. PLUMBING M NY LOM/(J �jQmQQ -ivQ W 01 v z SIGNED BY TEL N0. C t Approved By 4 Rough—In Date Final Date A **COMBUSTION AIR SHALL BE PROM ED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES. SUBJECT - PE City of Fridley 28480 AT THE TOP OF THE TWINS BUILDING PERMIT f RECEI COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 73Y i r PROTECTIVE I NUMBER REV GATE PAGE OF APPROVED By CITY HALL FRIDLEY 55132 1 612-571-3450 910-F5 10/30/98 1 1 JOB ADDRESS 5649 5th Street NE I LEGAL LOT NO. Pt. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Ift. 2E, 29 2 I Hamilton's Add. to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Al Schnobrich 574-9475 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO D L Builders 1166 14th Ave SE M is MN 55414 378-0950 20096711 1 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK J; REPAIR ❑ MOVE ❑ REMOVE ❑ NEW O ADDITION ❑ ALTERATION B DESCRIBE WORK Reroof house and garage (23 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1971 .98 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S UCTION OR TynPERFORMANCE OF CONSTRUCTION $62.25 Fire SC $1.97 PLAN CHECK FEE TOTAL FEE $70.20 SIGNATPREO CON'RACTORORAUTHOAIZEDAGENT IDATEI WHEN PROPERLY VALI THIS IS Y(pO�UR PERMIT _ 'AeEJD✓D fL( ,A . c S-GNATURE OF OWNER„F OWNER BUILDER, IDATE, SLOG IN rIAtE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Q® BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: A Tel. #!�;'jy _%q -7S Contractor: % _L , �v;\c�i�25 MN LICENSE #2o0,W,.-7 1 i Address: ( - 71E lA Tel. FDIS Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: & 0,d Sq. Ft. Sq. Ft. Sq. Ft. Construction Tyre: C4t &W2 Estimated Cost: /?17 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: /D -3D • li fs APPLICANT: Tel. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ S. oo CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] Building BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY 1 Date: APR �o I 763-502-4977 FAX EFFECTIVE 1-1-2010 ` DATE d `� �3 Z G/ O YOUR E-MAIL ADDRESS SITE ADDRESS y S�� S T v L� MAi THIS APPLICANT IS: ❑ OWNER 06NTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: t -A -T iA /,J SUBMIT A COPY OF YOUR STATE LICENSE -STATE LICENSE #_ -2- C) G -7 22C a EXP DATE Q3 3/ : O / Y AND CERTIFICATE OF ADDRESS: / CI / fii em r tuc el 6 r Ll i CITY JC -M eft" STATEN/" ZIP S]Z= INSURANCE PHONE (ort -532^ 7Co75- FAX /Z-23S-(03e�U PROPERTY TYPE ErsrNGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYMEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEJSHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ RgOF ❑ DRAIN TILE 13DECK 2TIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAWTENANCE/REPAIR '❑ REMODELING DESCRIBE WORK BEING DONE:_ �e l - S SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SEWNG FOR NEW CONSTRUCTION INCLUDING DECKS, Vinyl ❑soffit ADDITIONS. & PORCHES SUBMIT: ❑ Alwninum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and Proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SIN T 1997 U.B.0 FEE SCHEDULE) COTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ /00.0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ftx $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks savable to: Citv of Fridlev Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT Q ate�PttiNT NAMES�, M %�DATE WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H�. �,f County Name WELL AND BORING SEALING RECORD M nna leso No. Unique Well No. Lj / Minnesota Statutes, Chapter 1031 or W -series No. AN OKA (L— bl.* It -11—) Township Name Township No. Range. No. Section No. Fraction (sm. — Ig.) Date Sealed Date Well or Boring Constructed FRIDLEY 30 24 1 23 SE NE NW Wednesday, January 18, 2012 1958 GPS Latitude degrees_ minutes_ seconds Depth Before Sealing 24 tL Original Depth CWI no record ft LOCATION: Longitude_ degrees_ minutes_ seconds AQUIFER(S) STATIC WATER LEVEL Nu t Address or Fire Number and City of Well or Boring Location EXingle Aquifer ❑ Multiaqu'der 01/18/12 5622- TH STREET NE, FRIDLEY, 55432 WELLMORING �4neasured ❑Estimated Date Measured ❑ Water -Supply Well ❑ Montt. Well Show exact location of well or boring Sketch map of well or boring LAWN 16 ,�r In section grid with -X.° location, showing property ❑ Env. Bore Hole ❑ Other ft. fvelow El above land surface N I lines, roads, and buildings. CASING TYPE(S) — `��cc, Galvanized T&C house EXteel ❑ Plastic ❑ Tile ❑ Other d t i WELLHEAD COMPLETION ��//I W ; E wet Outside: ❑ Well House Xt Grade Inside: ❑ Basement Offset 'h Mile \ ❑ Pitless AdapterlUntt ❑Buried El well Pit F-1 rnrea os ❑ Buried s — iTi�� J _ ....... ❑ Other 1 MIS❑ I Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) SCHNOBRICH JAMES Diameter Depth Set in oversize hole? Annular space initially grouted? 2.00 in. from 0 to 21 ft. El yes [lo ❑Yes ❑ No El Unknown Property owner's mailing address ff different than well location address Indicated above 7720 WEST CANTERBURY DRIVE PEORIA, AZ 85345-8275 In. from to fL ❑Yes ❑ No El Yes ElNo El Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown WELL OWNER'S NAME/COMPANY NAME '' SCREENIOPEN HOLE SAME Screen from 21 t0 "24 ft. Open Hole from to ft. Well owner's mailing address it different than propOrty owner's address' indicated above SAME OBSTRUCTIONS ❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ FII ❑Mlo Obstruction Type of Obstructions (Describe) No Obstructions Obstructions removed? E] Yes ❑ No Describe GEOLOGICAL MATERIAL COLON HARDNESS OR FORMATION FROM TO If not known, indicate estimated formation log from nearby well or boring. PUMP Typo Piston Pump & 20 Gallon Tank GEOLOGY FROM: 6336 STH ST EET NE [iemoved ❑Not Present ❑Other Sand Q 32 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: ❑�lo Annular Space Exists El Annular Space Grouted with Tremle Pipe ❑ Casing Perforation/Removal Sand Cla 3 4 In. from to ft. ❑ Perforated ❑ Removed Dry Sand 4 54 in. from to ft. ❑ Perforated ❑ Removed Sand & Gravel 8 Type of Perforator Well = 3" X 82' ❑ Other Screen = Johnson Static Water = 46' GROUTING MATERIAL(S) (One bag of cement = 94 [be., one bag of bentonite = 50 lbs.) Grouting Material Neat Cement from 0 to .5 n 0.0815 ygaRQnS bags Enviroplug from .5 to 24 fL 3.8305yP&9g bags from to ft. 0 ygd0nS bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes ❑xAo How many? REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING Well Located North Side Of Garage LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report Well Depth Measured From Grade Level is true to the best of my knowledge. M.D.H. Inspector Was Not On Site During Well Sealing Myron L. Malenke /Njalenke Water (763) 493.3650 1426: A Licensee Business Name license or Registration No. Received Well Sealing Notficalton,From M.D.H f M. L. Malenke - 347: A January18, 2012 PID 23 30 �4/ 31 0028 d5difiedRepri Cued Rep. No. Date Y LOCAL Cy7PJHri, A 73 Name of Person Sealing Well or Boring HE -01434-12 IC# 140-0423 9/09R