1055 Cliff Rd - Septic Maintenance Form 2016-11-25Wyk
City of Eap DEC 0 51016
3830 Pilot Knob Road
Eagan IVIN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: CoMMdavflnnmp#/c�_;*.._fe
22agaLn.com
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For Office Use
Date Received:
I Staff:
L-------------------- I
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped:. l# of Tanks Pumped:
Site Address: z Total Gallons Pumped: _0
Owner's Name:
<
Owner s Address (if different from site):
Maintainer's Name:
k(5 (5 ,� License Number: Z
Private Residence: Commercial: Disposal Location:
Condition of Baffles: U lLType of Tanks:
C4 A of Tanks: LCF
Pumped Throuoh: I
Effluent Sewage Discharge: Yes- No:
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.