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835 Cliff Rd - Septic Maintenance Form 2016-06-01 --------------------- For Office Use I d l�; I Date Received: .J I an City of I Staff: EandH 3830 Pilot Knob Road Eagan MN 55122 Phone: (651)675-5675 Fax:(651)676.6694 Email: commdevelopment(&cityofeagan.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: e�;,' 'f—,PO/ � #of Tanks Pumped: Total Gallons Pumped: l U y j Site Address: �7>-5— GG) a Owner's Name: PA ) A- 0UL'`i1SK Owner's Address(If different from site): License Number;Maintainer's Name: I .Y— 2 Private Residence: Commercial: Disposal Location: Condition of Baffles: O �� Type of Tanks: E(=L'T, Size of Tanks: /LD W Pumped Through: i/ .t Effluent Sewage Discharge: Yes: No: ^ Comments: Please submit completed forms to the Building Inspections Division via mail,fax or email.