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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 --------------------- 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.