Laserfiche WebLink
CITY OF ELK RIVER <br />P.O. Box 490 • Elk River, MN 55330 • (612) 441-4900 <br />Location of job y 7 J(� % %/�//U� If L UcA L'l le 2 l GLe4 <br />Owner -C#A (�1 d A i.L.L A Address Ak <br />Licensed Designer /,1A LE7A0 License # <br />Licensed Installer li�lZL�1'2 L�C�4ei�.r// License # <br />Signature !` Date its 4� <br />(Show location of house, tank, drainfield, property line and well) <br />W-4 ►P. <br />T <br />5 <br />If do <br />COP <br />E13- Ic <br />O <br />1 � <br />NOTE: On ALL replacements and additions, tanks must be exposed for baffle inspection. <br />COMMENTS: <br />New Work ❑ <br />Replacement—lia-1 <br />Addition ❑ <br />Outside Lift ❑ <br />Ejector ❑ <br />Gravity ❑ <br />Mound System - <br />Tank Size <br />Tank Size <br />Square Footage of Drainfield Area <br />De th of Rock Under Pipe <br />Depth of Rock Over Pie <br />Graveless <br />De th of Dirt Cover <br />Number of Bedrooms <br />DATE /0 - Zg- `J-"" <br />INSPECTOR <br />COMMENTS <br />THIS FORM MUST BE FILLED OUT BY A LICENSED INSTALLER (ASBUILT) <br />(1) CITY COPY, (2) OWNER COPY, (3) LICENSED INSTALLER COPY <br />