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# 003�
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION REGIUEST
Job Address: � V L �� Date: ��� T
Owner. 2 S C 1 C--
Legal �a No. s�ock �aai�«,
Description � � �)�� — �
Plum ' Co.��t> ' �v�e-'�' Master Lic. #����
I agree to II for ection r uncovering the damaged line, before arry repairs
are m an hen the r ir is made but before recovering the line.
�
INSPECTION FEE
Water Line ❑ Sewer Line� Repair ❑ Relocation �
Fee: Fee: J����� Per Chapter 206, Fridley City Code
Total: r��Ct� Receipt # � ��
INSPECTION RESULT
Approved � Denied O Comments
Inspector: Date:
White Copy—Inspection DepL • Yeliow Copy—Plumbing Co. • Hard Copy—Water Dept.
�
#
CITY OF FRIDLEY
UTILITY LINE REPAIR/RELOCATION INSPECTION RE�UEST
Job Address: Date:
Owner:
Legal �m No. Block Addition
Description
Plumbing Co.: Master Lic. #
I agree to call for inspections after uncovering the damaged line, before any repairs
are made, and again when the repair is made but before recovering the line.
Signature:
INSPECTION FEE
Water Line � Sewer Line'-J Repair ❑ Relocation r'
Fee: Fee: Per Chapter 206, Fridley City Code
Totaf: Receipt #
INSPECTION RESULT
Approved � Denied ❑ Comments �DR//Z i'�lA�� oN TNE l3�yd,
.�FT � �NTe 6'~� oNN�cT/oN .
Inspector: • Date: 'S' a7 ' 9'�0
White Copy Inspection Dept. • ellow Copy—Plumbing Co. • Hard Copy—Water Dept.