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~~. rTTY OF ELK RIVrR <br />P.O. Box 490 • Elk River, MN 55330 • (763) 441-4900 <br />r <br />_ocation of job ~ (~ ~Q ~ 4Z ~-v ~~ ', <br />9wner 1~''1 ~Y' ~ V~ 1 r'iP~L\ Address <br />.icensed Designer ~~ ~? ~~r~ License # cg ~ l - <br />+ +1Cr- License # ~ Ct~-/ <br />.icensed Installer ' ~ ~ ~ - <br />>ignature Date ~- aG - y'~ <br />(Show location of house, tank, drainfield, property line and well) <br />N <br />W ® P. <br />+ <br />5 <br />a~ <br />..~ , <br />p2,~ <br />~~h <br />~~ ~4 <br />~~ vSh <br />t ~ ~ _^_~ / <br />.~ <br />~! E-^1 F~ ~.L. <br />.~ <br />c~s~ n~ sr n i w'~a.~ <br />C .~' ~ . ~~ mss, ~}~ ~_._ <br />n~1• 1 <br />~ /~fi'" a <br />~ ~jpp~i~l+y} <br />P~i~' ~( <br />'~~ ~~~ "7 ~C rr2 <br />~~r~~ fi~~ <br />,!. <br />• C~•G~ <br />'~? <br />C/ <br />.~'L`5L . <br />s~~~. ~ 1 <br />r •s? <br />!/ _/ ~ ~ ~ <br />IE""•~ <br />~ad5i ~~~~~ ~`~ <br />r~/hZ f <br />h~~ #~sn <br />~'~~~ ~~~y )mac r <br />`~~ L,o sue, ~ <br />.` ~ ~~r~Q <br />r~ 7 73L1j ii;~(f{i /Cr <br />,r <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 D <br />Tank Size I'Zcc~ C` <br />Tank Size ~~ ~~ <br />S uare Foota e of Drainfield Area ~ Z <br />De th of Rock Under Pie ~~ <br />De th of Rock Over Pie ~ ~ `t <br />Graveless <br />De th of Dirt Cover ~'' ~~~ <br />Number of Bedrooms <br />THIS FORM MUST BE FILLED OUT BY A LICENSED INSTALLER (ASBUILT) <br />(1) CITY COPY, (2) OWNER COPY, (3) LICENSED INSTALLER COPY <br />DATE B ~" ~C"' <br />INSPECTOR <br />COMMENTS <br />