Laserfiche WebLink
~~e/ CVTTY OF ELK RIVrR <br />P.O. Box 490 • Elk River, MN 55330 • (763) 441-4900 <br />~- <br />.ocation of ~ob ~ ~ ~ ~Q 142 "`~ ~V ~..~ ~`~' ~~'c-' `~r.,2, ~~ ~'`-~ ~ ~`~ Z. ~~ °~- <br />,l <br />owner 11`1 ~r i -A. I r'~~\ Address <br />,icensed Designer ~~ ~? Fr~ License # c~ ~ t <br />+ +ll~ License # C~~ <br />.icensed Installer ~ C i _ <br />>ignature Date 8 - c~Ci - y~~ <br />(Show location of house, tank, drainfield, property line and well) <br />N <br />w -®-e <br />I <br />s <br />l .. <br />~ ~y ~zz <br />., , <br />. ~ p~. t <br />v.h <br />,~ <br />~ '~ ~ ~ ~ ~ al~h <br />t -~_ / <br />r ~~L. <br />~ ~ T ~~, <br />r <br />t ~~ <br />~S ~!S ,ah ~ ~ <br /> <br />I <br />I°~ : ~ .c.------ <br />~- r+y <br />'V <br />`,~`2 <br />~' / c <br />W~ <br />f ,lk~se.. <br />~adsr ~~~~'7 <br />Y,~~ a ~.. ~r'a ~ ~"~ <br />~-f~ ,,, d `~' <br />c O SO/~ <br />1 71~3'1J <br />~~~ 1 <br />~!`~ I '''' ~`~Z! <br />,Sa <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 Svstem ^ <br />Tank Size ~~zo'' <br />Tank Size K~ ~1 <br />S ware Foota e of Drainfield Area ~ Z <br />De th of Rock Under Pie ~~ <br />De th of Rock Over Pie ~ r `~ <br />Graveless <br />De th of Dirt Cover ~'' ~~~ <br />Number of Bedrooms <br />DATE FS -- ~Q- ©~ <br />INSPECTOR <br />COMMENTS <br />THIS FORM MUST BE FILLED OUT BY A LICENSED INSTALLER (ASBUILT) <br />111 CITY COPY, (2) OWNER COPY, (3) LICENSED INSTALLER COPY <br />