1075 120th St - Septic Maintenance Form 2016-03-11Mar 16 16 01:48p Bob Freiermuth
CRI ofEap
3930 Pilot Knob Road
Eagan UN 55122
Phone: (659) 675.9875
Fax: (651) 675.5094
Email: commrfevPeloo enpftitvafeaaan.com
Date Pumped:
Site Address:
Owners Name:
6514374327 P.1
i -- –.-
----------–
For
Deb IRecelvect a o 1 I
i scarf I
SEPTIC SYSTEM MAINTENANCE FORM
3-11-16 OofTanks Pumped: 2 Total Gallons Pumped: 2000
Dakota County Parks -- Lebanon Hills Maintenance Shop
Owner'sAddmss (if different from sits): 1590 Highway 55, Hastings, MN 55033 (Bill _ to:)
Maintainer's Name: Bob Freiernuth Sanitation LLC Lla®nseNumber. L492
Private Residence: Commerdal: x_ Disposal Location: Laai2c, AAO.
Condhion of 138M 05: �!�
Type aF Tanks: /� ciao of Tanks:
rr � (J
Pumped Through: Effluent Sewage OischaMe: Yes: No: �—
commerAs:
Flamm submit compiatod forms to the Building inspections Division via maB, fax or emalI.