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l~ rTTY OF ELK RIVrR <br />P.O. Box 490 • Elk River, MN 55330 • (763) 441-4900 <br />tion of ~ob ~ ~ ~I ~a )4Z~`~ A.V ~..~ ~ ~ SG=~T~C~ -~-~YZ, '~~~ ~ ~~Z ~~ ~6- <br />_oca ,~ <br />owner I'Y'1 ~r 7 ~ ya. 1 r~L~ Address <br />.icensed Designer -1~~ ~ ~Fr~ _ License # cJ ~ l <br />+ ' h~ License # ~3(d~ <br />~icensed Installers ' ~ ~ " ~~ <br />signature Date ~ - c~U - v'~ <br />(Show location of house, tank, drainfield, property line and well) <br />N <br />W ® F <br />1 <br />Ch a~ <br />.~ ~ <br />p2,~ <br />C; <br />c~.h <br />~~ al~h <br />~, 1, <br />L' r ~ ~ _ / <br />f 1~L. <br />~.~___.., ,, r <br />~r-- ~~.. <br />GAS T'~~CS/h/~ t.4!+?1~ <br />~ n-c{1. 1 <br />~g -r'nr5 „h <br />' IQ"" p ~ <br />I ~ <br />s+`1 <br />~,~;.v~ ? <br />X32 ~aZ ~?a~ a-.~yc <br />/7~ ~-'~'~z I <br />L~ <br />fi •° <br />~s? <br />/M/r- zZJ ~ <br />;~~ _ _ <br />,iL. L..,,, ~C~Y' <br />~a~s, ~'~~~~ <br />+r h Z ''`',f' <br />~~~~ ~~h~~a ~~~r <br />`! j~tia~, <br />~JQ U+O SOl~ <br />7f~3~J ~;~~~~ <br />' V <br />NOTE: On ALL replacements and additions, tanks must be exposed for baffle inspection. <br />COMMENTS: <br />New Work ^ _ Outside Lift <br />Replacement ® Ejector ^ <br />Addition ^ Gravity ^ <br />Mound System ^ <br />Tank Size I'Zcta C-i <br />Tank Size ~~ ~1 <br />S uare Foota e of Drainfield Area ~ 2 <br />De th of Rock Under Pie ~~ <br /> <br />De th of Rock Over Pi e ,. 4 ,, <br />Graveless <br />De th of Dirt Cover ~'' ~~ <br />Number of Bedrooms <br />DATE ~ " ~0- 4 <br />INSPECTOR <br />COMMENTS <br />THIS FORM MUST BE FILLED OUT BY A LICENSED INSTALLER (ASBUILT) <br />~i ~ ('T'T'Y COPY. (2) OWNER COPY, (3) LICENSED INSTALLER COPY <br />