890 Lakewood Hills Rd - Septic Maintenance Form 2022-10-05City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: commdevelopment(a)citvofeagan.com
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{ Date Received:
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SEPTIC
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SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: t G - S 72. # of Tanks Pumped: 2. Total Gallons Pumped:
Site Address:
a L - vi V(37 o oo A i4,'l /J- yl 6,0
Owner's Name:
Owner's Address (if different from site):
Vlaintainers Name: (4cf S L % f (c f (," 8 i -v' License Number: L L/2 C
Private Residence: Commercial: Disposal Location: # 2 6
1
Condition of Baffles: L( Type of Tanks: PIZyC4J Size of Tanks: I cj06 —2-
Pumped Through:y• i 6-'i 1 fd �L Effluent Sewage Discharge: Yes: No: V/
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.