1260 Deerwood Dr - Septic Maintenance Form 2022-09-0701
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Cityof EaTa
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: commdevelopment(&citvofeagan.com
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For office Use
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( Date Received: 2 2 2
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SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: 7 ' f# of Tanks Pumped: Total Gallons Pumped: oOL-3
Site Address:
Owner's Name: G tV L A- (Z M V
Owners Address (if different from site):
Maintainers Name:��� License Number.
Private Residence: _� Commercial: Disposa': Location: #2 & - L.
Condition of Baffles: 6 6(1 o Type of Tanks: Size of Tanks:
Pumped Through: 'Ito/6 Effluent Sewage Discharge: Yes: No: V
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.