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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 --------------------- For Office Use { { n { { Date Received: iItl --------------------- SEPTIC -- 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.