1760 Cliff Rd - Septic Maintenance Form 2022-10-31AMINElb-
to
RJER
z IV City of Eaw
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: commdevelopment(a-citvofeagan.coM
---------------------I
For Office Use
I n '
I Date Received:
I i
I staff: ,
__________________
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped:
2 Z # of Tanks Pumped: Total Gallons Pumped:
Site Address:
1-16v C II Pf- 6�r�a
owner's Name:Q t3 6 (✓ 6,Q SC)
Dwner's Address (if different from site):` �[
Maintainer's Name: vi f1W G;� t IC" d License Number:
Private Residence: V Commercial: Disposal Location:
Condition of Baffles:
6\C— Type of Tanks: P2( � `� 7— Size of Tanks: 6
Pumped Through: jyjI3 t kf C-- Effluent Sewage Discharge: Yes: No:
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.