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:
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For Office Use
I
I Date Received: 12—/2/2Z
i I
I stab: 42 GZ
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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.