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915 Lakewood Hills Rd - Septic Maintenance Form 2022-10-27City 0f Eap 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment(c cityofeagan.com Date Pumped: Site Address: Owner's Name: --------------------- For Office Use I I Date Received: 12—/2/2Z i I I stab: 42 GZ ------------------- SEPTIC SYSTEM MAINTENANCE FORM # of Tanks Pumped: Total Gallons Pumped: 325 Owner's Address (if different from site): Maintainers Name: (� /���Q-� S��f'� I o mplA License Number: L k do 'lD Private Residence: 'VI` Commercial: Disposal: Location: Z (✓ij `L. Condition of Baffles: d I L Type of T anks: CL S-6 P Size of Tanks: Pumped Through: t A1,3FMI r V .t Effluent Sewage Discharge: Yes: No: V Comments:_g.CvKc-,-(Lj e e?6) Please submit completed forms to the Building Inspections Division via mail, fax or email.