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1035 Cliff Rd - Septic Maintenance Form 2022-04-07Cit Y � of Ea an 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment(a-cityofeagan.com --------------------- For Office Use I I I I I Date Received: I I I I Staff: L -------------------- SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: # of Tanks Pumped: Total Gallons Pumped: k5oc3 Site Address: Owner's Name: 1 V l t S1e- CL Owner's Address (if different from site): (� 1 Maintainer's Name: \—G• KO Ck� S License Number: D o d Private Residence:_ Commercial: Disposal Location: � ��Y'M�N\� Condition of Baffles: ��c�s�1�. — \Y�L� Type of Tanks: S,--p-i, L Size of Tanks: Pumped Through: Comments: Effluent Sewage Discharge: Yes: No: X C -o rn�c3�t}w�e,n�4- 1 Scu ry `-`1 `i Ott 3" Please submit completed forms to the Building Inspections Division via mail, fax or email.