BP0001TYPE OF INSPECTION ROUGH FINAL AMOUNT DUE DATE PAID SUB-CONTRACTORS
Temporary Service
Footings
Framing
Permanent Service
Plumbing
Electrical
Heating
Air Conditioning
Septic/Sewer Inspection
Water Inspection
Sewer Tap
Water Tap
Remote
Final Inspection
COMMENTS: /
DATE
drill a well
5/ 10/ APPLICATION NO.: AMOUNT PAID:
5 10 / c~PERMIT NO.: 1 ADDRESS:
NAME: Jensen Well/Huntel LOCATION: 1 ~ ~ G ~ 'nth sT ~"''
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APPLICATION FOR PLACEMENT OF PRIVATE WELL
Date May 10, 1989
Property Owner Huntel (Richard A. Hunt Etal)
1638 Lincoln ree
Address Blair, Ne. 68008-0400
Company doing the drilling Jensen Well Company
1947. Park ree
Address Blair,Ne. 68008-04-00
Location of Proposed Well 5' N of the S property line & 5' W of the E
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35' feet from nearest sewerage system 35' public private
feet from any other water system public 85' private
Intended use of Proposed Well cooling and heating by way of heat pump
Depth 135' Size and type or nature of casing to be installed
6" NSF approved PVC plastic
Description of pumping equipment to be utilized in said well
submersible pump
$ 10.00fee to be accompanied with this Application, fee shall be non
refundable if Application is denied.
These provisions also apply. to Test Wells drilled within the Municipal
Limits.
Applicant and/or Property Owner agree to allow periodic inspections for
possible cross-connections.
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Received b ~~; -~~ ~~
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Approved by
Director, Public Works
Inspected by
Building Inspector
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Signature of Applicant
Date
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Date ~
Date
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S 75' Lot 27; 575' Lot 28, 575' W 5.5' Lot 29 Blk•46 114
75'
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Ind~~ate tiorth
Center Line o:~ Lincoln street
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Ap~~l it•ant