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1031 Cliff Rd - Septic Maintenance Form 2016-05-02 --------------------- For Office Use � Date Received: I no I city of EaEffn I Staff. 3830 Pilot Knob Road MAY z ox ?--------------------I Eagan NIN 55122 Phone: (651)675-5675 Fax: (651)675-5694 r Email: commdevelopment(dcitvofeaaan.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: -���P #of Tanks Pumped: 2, Total GWons Pumped: �l V Site Address: �d f C11 ' d1 pGf G� E�jcty[ /Y?N J /Z3 Owner's Name: ���°u-S �� tV a-,r`/"/et J, A) oreee i Owner's Address(if different from site):ar7 Maintainer's Name: oll/ e � 21?2q Private Residence: Commercial: Disposal Location: Jaqj s` �- 2T 6-- f;,P -1, eld- s�G Condition of Baffles: d Type of Tanks: C4fl Size of Tanks:ls-&'A4'-0 f o'vv fu 'Y"r Pumped Through: (4 �OfIL Effluent Sewage Discharge: Yes: No: Comments: t8 ➢Py+'ns`tt Please submit completed forms to the Building Inspections Division via mail,fax or email.