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PRE 2010 DOCSCity of Fridley, Minn. N° 8022 IndVIIVWPERIVIIT Date: June 24, 1965 Mover 1lAT,F Owner: Mintel ske r MO y .- INC Address Address 7816 Central Ave. N. E. LOCATION OF BUILDING No. Street Part of Lot Lot _ Block Addition or Sub -Division Corder Lot — Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost _$13.01)0.00 _ To be Completed MOPING HOUSE FROM 7816 CENTRAL AVENUE N. E. TO : 5801 6th Street N. E. 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 setorth and In pliance with ;hprovisions of ordinances of the city of Fridley. In consideration of the payment of a fee o 1®permit is hereby granted to Dale Movex;,-jnc,, 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 dame in, around and upon said building, or any part thereof, shall conform in all respects to the ordinance=s of Fridley, Minnesota location, c onstruct[on, alteration, maintenance, repair and moving of buildings withincity limiffir aad�th s permit may be revoked at any time upon violation of any of the provisions of said A11en Jensen suilaing NOTICE Ibb po mh don not eaar the aende cow, hwr& w for r Mh& plumbing, ga haring, Sara or wets. Be am to me the swmb g agar for spm to pamht for thea head. APPLICATION FOR MOVING PERMIT r - No Fridley, Minn. °19j�r Inspector of Buildings, 6431 Univ. Ave. N.E. The undersigned hereby makes application for permit to move building as herein specified, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Department of Buildings, and hereby de- clares that all the facts and representations stated in this application are true and correct. Present Location Lot Block Addition To be moved to: .5- e -% ;Kel f Routing:��% Distance moved ft.To be completed about 19L.— Taxes paid? Estimated cost $ Foundation and alteration permit numbers Certification as to cost: I hereby certify that the above designated building is worth at least sixty (60) per cent of the cost of a simi- lar new building. Approved by: Utilities Notified: Signed Owner or Agent Water & Sewer Department (Title) Minneapolis Gas Co. (date) (Title) Northern States Power Co. (date (Title) Northwestern Bell Telephone Co. (date) Signed w a Tensed Mover (See reverse side for instructions) City Engineer In the event that the moving permit is to be applied for by the owner or by any other person than the licensed Mover, the following letter must be completed and signed by said mover: t .. Inspector of Buildings, 6431 University Ave. N.E. Fridley, Minnesota Please issue the bearer of this application, Mr a permit to move building from Date 19— to: to which I hereby authorize him to sign my isms. Signed Licensed Mover GENERAL INSTRUCTIONS The following must be secured before moving permit will be issued: 1. A building permit for new location of building to be moved. To obtain this building perll it, the following is required: (a) The building to be moved must be inspected for structural soundness by the building inspector. Phone this office for inspection. SUnset 4-7470. (b) A survey of lot to which building is to be moved. This survey must be made by a licensed surveyor. (c) The building and moving permit must be obtained at the same time. 2. Tax receipt showing that all real estate taxes due have been paid. Duplicate receipts may be obtained at Anoka County Auditor. 3. Approval from the Fridley Water and Sewer Department showing that bills chargeable against the property to be moved have been paid and water connections have been discontinued at the curb line or at the main. (See reverse side of form.) 4. Approval from Fridley Director of Public Works office approving routing. 5. Notification to, and signature of utility companies. (See reverse side of form.) (a) Minneapolis Gas Co., 739 Marquette Ave., Engineering Department, Fourth Floor. (b) Northern States Power Co., 15 South 5th Street, Application and Extension Department. (c) Northwestern Bell Telephone Co., 224 South 5th Street, Business Office, First Floor. 11 250-8-58 • F i 0 City of Fridley, Minn.. BUILDING PERMIT Date: June 25, 1965 Owner: C31"f rd M3stelske Builder Address 5801 6th Street N. E. Address Same LOCATION OF BUILDING No. 5801 Street 6th Street N. E. Part of Lot Lot 6. 7 & 8 Block 32) Addition or Sub -Division Hyde Park Corner Lot Inside Lot Setback Sideyard Sewer Mevation Foundation Mevation DESCRIPTION OF BUILDING N° 8030 To be Used as: Dwelling to be Fromt Depth Height Sq. Ft Cu. Ft. Mored in Front Depth Height Sq. Ft. Co. Ft. Type of Construction Frame F&L Cost T$7 , 000.00 To be Completed Dwelling to be Move in In consideration of the issuance to me of a permit to construct the building described aboveI agree to do the proposed work in accordance with the description above set forth compliance with of l provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to C. Mistelske 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 dome in, around and upon said building, or any pmt thereof, shall conform in all respects to the ordinances of Fridley, Minnesota �g location, construction, alteration, maintenance, repair and moving of buildings wiothin the . city limits his permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building Inspector NOTICE 'ftp ponk don dot emu tis aoastraaHon, haft9fiftn for wbina, phaabtae, Yn beatiao, aara or wala. Be wro to sad t6 SWWIng b **dW for aapords paradts for fossa boas. APPLICATION FOR BUILDING PERMIT ETJ OF FRIDLEY, MINNESOTA OWNER'S NAME . BUILDER ADDRESS_ ADDRESS LOCATION OF BUILDING Streeter ,Part of Lot LOT R = ADDITION OR SUBbIVISION s Corner Lot Inside LOT Setback �j Side -Yard 1.1 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 b used as: Front Dept Height— C Sq. Ft. Cu. Ft Front Depth _Height Sq. Ft. Cu. Ft. Type of Construction Estimated Co�� 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_L —�L� /SIGNATURE (Schedule of Fee Costs can be found on the.Reverse Side). El MONTH DATE DAY � _- -'-INSPECTION & ADDRESS CONMENTS -/' 0 fil � -- 3� City, of Fridley, NffimrL 11722 6431 University Ave. N.E., Minneapolis, Minn. 55432 BUILDING PERMIT 'Date: - October 13- 1972 Oma; Clifford R. Mistelske Builder Bill Trombly Address 5801 - 6th Street N.E. Address LOCATION OF BUILDING No. 5801 Street 6th Street N.E. _Y_ Part of Lot Lot 8 Block 32 Addition or Sub -Division _ Hyde Park Corner Lot Inside Lot X Setback _... Sideyard ._h' from N- line of Lot 7 Bower Mevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front 24' Depth 24 Height lot Sq. Ft. _ 576' ca. Ft. 5760' Front Depth Height Sq. Ft. _ _ Cu. Ft. Type of Construction Wand Frame Est, Cost ._ ,$.2s 60g _00 To be Completed 1 year Stipulations: Provide a hard surface driveway. Frost footing agreement signed by owner. Garage to be held 6 ff feet from the north line of Lot 7. In consideration of the issuance to me of a permit to construct the building described above, I agree to do ft proposed work in accordance with the description above set forth and in o pliance with ovisions of Ordinances of the city of Fridley. Vt 1.30 State Suidharge In consideration of the payment of a fee of $__11_,.00_, permit is hereby granted to Clifford Mistelske 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, maintenance, repair and moving of buildings .Within cele. city limits and this permit may be revoked at any time upon violation of any of the provisions of sand ordCl(a�A 7 A ('T ARFNf R RFT T T F NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the 611ding Inspector for separate permits for these items. t APPLICATION FOR RESIDENTIAL, ALTERATIM OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOTS ' $LOCKS AWITION: COMM LOT: FIDE LOT; SETB m SIDEYARD: F AM icas<ut attach to thU #4m io Certificates of Survey of Lot and proposed 4, CA hetld J;mation dram ou the" Certificates, — DESCRIPTION OF BUILDING To Be Usse4 As,. 04� tet:', T ,Reight: Square Feet; � ;:�- „? 4, Cubit Yvet; - V ,. Front= Depth; Height: Square Feet; Cubic Feet;, 'yfa of Oonetructioul a `�iG., s Estimated Cost:- $ u D To So doted $ ,,,.. �.� a4.-. TM andwoigned hereby asskes application for, a permit for the work herein #pacif#.ed„ agreeing to do all [pork in attict accordance with the Oi.ty of M41,my ordtnauces 4A4 jUtjW of the Department of Buildings., mW hereby 4U0jAZ*q OWX all the JEacts 404 representations stated is this application ass true =4 correct, a �., �.`�-Z,� . SIGNATURE: (No Revorge We For rAdditlonai Infomation. ) i� � � �� ' � � r- � V V � qq owner of the property located at Ij have no objection to the City allowing the construction of a��,� 1 to be located at� —a t�_ without the required certificate of survey that the City ordinarily requires for all new construction. Signed ` Address Witness Date • • TYPICAL SLAB DETAIL y • C 2" 66 x 101 m vire m e s h IS Grade 2—r 4 Re-Bars c f s 45° 12" Min, e" Min. S The above is a substitute design for frost footings, hwever, itis not yet accepted by the State as an amendment to the Uniform Building Coae, Section 2905,a. 74erefore upon using this method of construction, I agree to hold the City of Fridley harmless of any possible claim for foundation failure or structural damage caused by foundation failure. Ilk `L a With s Property Owner Date Address ofrroperty/Legal Desc. 1 • SUBJECT PERMIT NO. - City of Fridley 29790 AT THE TOP OF THE TWINS BUILDING PERMIT r � RECEIPT NO. � `v _ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. �®�� r PROTECTIVE E . NUM9ER REv OATE PAGE OF APPROVED BY i 0.0 ---- �'� CITY HALL FRIDLEY 55432 1 612-571-3450 910415 6/29/99 JOB ADDRESS 5801 6th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8, 9 32 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Menard 685-2060 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION )dC REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (30 S) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS s i Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 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 STALLS 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 $2622 I $1.31 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE 87.18 SJONATUPEOFCo ACTORORAUY'OR AGENT 'DATEiWHEN PROPEFKV VALIDATED THIS IS YOUR PERMIT 01 0 9 iNgP rJATE p&PGNATtAECFFOWNEROF OWNERS RDEAI �D TES NEW1 ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address:0 �{ me %c Legal Description: / Owner Name & Address: �o kv� �e�� d l 6 S� AIC Tel. # � F5 "a0 4 Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTIE> R: V- .e aVI - o Construction Type:_ 0O Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: l ' APPLICANT: Tel. CITY USE ONLY Permit Fee $ , 3 Fire Surcharge $ State Surcharge $ - •3 (' SAC Charge $ License Surcharge $ Driveway Escrow Erosion Control Park Fee Sewer Main Charge Ifell1FA4 I $ Y7 / Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] - SUBJECT City of Fridley 29828 AT THE TOP OF THE TWINS BUILDING PERMIT (' r? i O' _-_-� COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. r I I � NUMBER REv DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55132 612-571-3450 910-F15 7/6/99 ,OB ADDRESS 5801 6th Street NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 8 , 9 32 Hyde Pak SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Menard685-2060 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION )(R REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside house and garage-, 9 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. Install smoke detectors to meet the State Building Code in each sleeping room and on each level of the house. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. 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 STALLS 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 4500 $2.25 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $111.25 Fire SC $4.50 PLAN CHECK FEE TOTAL FEE SiATUpE OF CON' ACTOR OR AUTNORi ED AGENT .DATE, WHENJWQPERLY lu BLDG IN$p - VALID ATED THIS IS YOUR PERMIT OATE S, ATURE OT OWNER,IF OWNER BW DER, $DATE, NEW [ ] 1 Effective 5/10/99 ADDN [ ] CITY OF FRMLEY ALTER SINGLE FAMILY DUPLEXES R -Z AND - [ ] AND UP R 2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Tel. # (A S ao lk U Contractor: MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: k-4� e c?.s.. �� n 0, V-4 Q fl 0.v�c,• R-2 n Construction Type: Estimated Cost: $� 0 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ 151 DATE: APPLICANT: Tel. # TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ ��1 �-� Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ ��Zd-� $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: 01'07/2000 10:45 E H RENNER & SONS 4 5711287 C 010do—VIZ!, NO.438 1702 x`31 ❑ Yes ❑ Ne ❑ Unra+oem CASING TYPES) e a �IpA,L Op gGp4O LOCA71ON MINNESOTA DEPARTMENT OF HEALTH WELLAND 86RING SEALING RECORb Nf�nnaOte Mn � " �H s�.�62 Ofameter Ooh M10mvte Stati�lao. Chapter 1031 , ;WOO N06 — m Wsef(e9 No. TowneNP No. R�7e1^Be No. Soelom No. Frocuof ism. -w l�q.1 ' to Seai�tp D9je well or (faring Co ammit t► In. from 1 30 2.3 `'� 2.� +ieeE4 sr y Nmvwfwal Sheer A2&— w Fwe N-uw and City of wail or emmg Cawiron 5801 GM Sof Jraz7 roeeffwt as rt9!! w Uofirlg Skewh moi, of wetl at boring DR w m Tool `)C. be060. shawine ProDenp N is litres. rwas. am Duadinp 3 era maft eA4ve ddarefe+q]Ron.ml Ioeelmn 161ST tin T, UK $5632 DOOM Before Scaling ' 3'4 I►. Original OeP* 2 tr Sn+gle AaWer O Murliaquller (�Meeaured ❑ Eetunsled fl• • wmw ❑ Moe land srrltacs, Sol in waske note? IR wafer SUPOY well O man". wolf ' ❑ En., Bore Holo ❑ Ddrer x`31 ❑ Yes ❑ Ne ❑ Unra+oem CASING TYPES) e a S(Sleel ❑ Plasf(e ❑ Tile ❑ Otto CASINOM Ofameter Ooh '� ins from � to �•3 h. in, troy m ry a lfteatad Beate. In. from (�Meeaured ❑ Eetunsled fl• • wmw ❑ Moe land srrltacs, Sol in waske note? A -am &oa- irdd* www? C) Yes fsNo ❑ Yes ❑ Na ❑ unknown 0 Yea ' O NO ❑ Yes ❑ Ne ❑ Unra+oem ' ❑ Yee . ❑ No ❑ yet ❑ Ne ❑ U1 WAM Saes„ ham 32 to—m—'.. open rare Tram m h VlhtiTfAf�I1We� - YFLL OWNEnNAME ❑ RO&QrWPIPS ❑ CmftVetvafs) ❑ DWIe ❑•AID- ❑ NoObanttrbn Ifao awrose'OdF✓tg.aol0r•6B n dilrarme altar yrapeny oenmre emeeea rrro{e&Ie0 neo ro. .Typo of Obanolote (OesOru) . ' - Cm obaruMtens removed? .R vol ❑ No Omlbe PUMP • .Type GEOLOOMAL MATERIAL COLOR MABONBBS OF FAOrIf TO ❑ Remfared * P1 Noll preffiri ❑ Oher FORMATION noel krn m, adicere ammelae tarmemen kg I eaaArweO m ymi,m METHOD -MO TO SEAL AWULAAr SPAQE BETWEEN 2 CASING% OP CASING ANO 808E HOLE. (3 No Anew® Soeee ❑ An. i. apace VM..d Tena Menthae pl, ❑ Camilo Peftera*vR8m vw In. from ro K ❑ Psr m and O PeyoUee in. Tran to h ❑ Poriin id ❑ Remowd Two w wrioratw ❑ Of1rer -GROUTING —MOUS) baa o1 M-111 a 04Iba6 one We to bw&anfeo . so Orel Greufing Morenci PMTW"item 35 m 4) R Ya,W wma flan m 11. Yams OW �� hfun to R yarQs bw IMKIL 8O11MtE OF OAYA. DIff=LflE9 Of MAMM OTMEA WELLS ANO BORIrIGS t Olney tmoaolod and unused well or corlsg on property? p Yee if NO ►seer fnenYt MR s IN VS". - S n P IICFNBFO ail itEmsr@pE0 coNTNACYoa CFat6acATtob1 rz � ?ARM: $OJ�+� t � "Off an e�er my�i�er, In aerofdmf� OM bUM¢aola IRAs. CMp+er rrts The infam adar os e�,+.a a o,in eporf ill S I� MM xm ccnrretlare NameSEALED r� -k„DK ueelroeaaPaeDnnre According to MN State Regulations. A�yA I=49 _ Imm -qdbwjmnjmtxmrm LOCALc'opv H .19126 AfeypadlgD,aDnsoeeegwbearGpi� 01/07/2000 10:45 E H RENNER & SONS 4 5711287 0 m1 ui &tvb NO.438 D01 i -1-0o m\ qEu Op gpj LOtAT10N MINNESOTA DEPARTMENT Of HEALTH Mirtrj mm IIl i end BMrlg j WELL AND BORING SEALING RECORD MIM"ut�e unique Wal( Nc. I H 161979 — Abn"M"11A S1pNW. Chapter 1031 cr W -series No. a+(rrOWN rmwrroA Tewr18a1D Ne• Raf1oB hle. $eat pM1 N6. Fratlon (am. i ly,) Dare swell 08115 well or Bonng Canstrtroted • •� 23 3 � ami ,o • �'� ,� e � 2�3d• � NuMilf lS"llf Aft— w Pira Numer oand Gly of well or 8onng t.ocaUen {t "01 ' Dapift Serots Searing �•� n. Original Depth a q. Srrow Ox191 Ixaliml of wen w bmso Skelan Mao of wall or Dwre I AOUIFER($1 STATIC WATER LEVEL h seetbn grid vrtn -X . N i ka-no O b brnprepory %Sfn919 Aawler 0 Muiaavulfor N MOramgs. WELUBORING ( hl8esumis ❑ Eel(meme .r. -.t-- -- wale suety Wel ❑ Morin. well ' —7 1 ❑ -Env. Sam wee' O other �F n. � betdw ❑ ebeva terra aunme w -tr -a--. -•I-- - I- .E 1.\tiy CASING TYoE(s) ¢- - -. •-j e $j 801561 ❑ Pieefre ❑ Tile ❑ Ditto, -�_ -•i-- ldrere �...�.M.JI - , -+- � cASINot� OWNER'S roromiWnO eddreon a dmwent oxen well 1161ST LAW ,We M SS303 ❑ AWitfDrap P ps .0 Che k Veba%) ❑' Dobtfs ❑ Pill 000 ud m a00-$ Imitated abera. Tjya of Coww"mla (Oeeowl. ObjumXa,s.removen ❑ Yea ❑ No Desafte 1 - TM f1EA1 QQL 1u?k7pit" LbLDA trARDNes80F PROP 0 Removae (qL Nol Present.. O Olbei fON Ai1OM 1st krro s� i rmoee eeanmp forsta4orr hep horn aaaray wel ar ear6t9• 10FMO USED TO SEAL AWA LAA SPACE METWEEN Z CABtNO& 09 CASINO AND DOM 0 RNe Annular m Space U Q amariatspmce grouted wly+ treble elle . O Oeairg PeAomUonlRemorrai in, ham to a ❑ Perlatated ❑ Rerrtd.OA In. from to it. ❑ po mates O P4, Type of peftm1 r ❑ Omer OAOUANO MATERtAL(SI (One see 01 comeej - N lbs.. are saga r betrj intit o W W Graunng Malenei front is to d It Irem to a. Yft aw tram to a. Pft mv rrwn to It f NMI, IMM! OF DATA. OfflICULMM w -, MAU= OTHER WEjdS ANO OOAINOS • . ow r ac m d wet unSOItIeO and m,useo *aa wring an propenyl ❑ re: No H" the tj/1 In .: o ucERsf?D oR nEOISTEREo coRTnaerDA C!!RTtPtCATION '8 �3� ! : 10125 mm too mWWIem iwcano �� earxmanoo rdttt tlAtmeaefe Rutea, cfraptar �K The tnfennalfon oerrl8ir,er! er +re west b C= 50 ' �.�. a .m Ill. 71015 SEALED Conneeanr6uetneasrosnre LowmeaJ�kbfldpnfao According to MN State Regulations A�xlxsfrs9Caw "ICAI COPY I N f Is let s� Capin IS ser in aversite halo') An Maf sXm 1 Waffy gl0eied4 C in,ham In. lrom to to It. ❑ vas in p.Ya• a. ❑ Yes (R. ft ❑ No Q No ❑ Voss ❑ No ❑ Uft" wn 0 vee ❑ No 0 untrown ❑ Yoo ❑ No 0 unwo" Nd rated eaove, SCREENrODEN HOLE Screen rrom 15 10 —18 R. Open Mote tmfn ❑ AWitfDrap P ps .0 Che k Veba%) ❑' Dobtfs ❑ Pill 000 ud m a00-$ Imitated abera. Tjya of Coww"mla (Oeeowl. ObjumXa,s.removen ❑ Yea ❑ No Desafte 1 - TM f1EA1 QQL 1u?k7pit" LbLDA trARDNes80F PROP 0 Removae (qL Nol Present.. O Olbei fON Ai1OM 1st krro s� i rmoee eeanmp forsta4orr hep horn aaaray wel ar ear6t9• 10FMO USED TO SEAL AWA LAA SPACE METWEEN Z CABtNO& 09 CASINO AND DOM 0 RNe Annular m Space U Q amariatspmce grouted wly+ treble elle . O Oeairg PeAomUonlRemorrai in, ham to a ❑ Perlatated ❑ Rerrtd.OA In. from to it. ❑ po mates O P4, Type of peftm1 r ❑ Omer OAOUANO MATERtAL(SI (One see 01 comeej - N lbs.. are saga r betrj intit o W W Graunng Malenei front is to d It Irem to a. Yft aw tram to a. Pft mv rrwn to It f NMI, IMM! OF DATA. OfflICULMM w -, MAU= OTHER WEjdS ANO OOAINOS • . ow r ac m d wet unSOItIeO and m,useo *aa wring an propenyl ❑ re: No H" the tj/1 In .: o ucERsf?D oR nEOISTEREo coRTnaerDA C!!RTtPtCATION '8 �3� ! : 10125 mm too mWWIem iwcano �� earxmanoo rdttt tlAtmeaefe Rutea, cfraptar �K The tnfennalfon oerrl8ir,er! er +re west b C= 50 ' �.�. a .m Ill. 71015 SEALED Conneeanr6uetneasrosnre LowmeaJ�kbfldpnfao According to MN State Regulations A�xlxsfrs9Caw "ICAI COPY I N f