1740 Cliff Rd - Septic System Maintenance 2016-05-09 ------ —`---------- i
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� ��-� • i Data Roeaived:_ I
. of Eagan _ I
I staff:
3830 Pilot Knob Road MAY 16 2016 1-------------------!
Eagan MN 55122
Phone: (651)675-5675
Fax: (651)675-5694
Email: Siommdeveloomen t(a.Cit ofeaoan corn
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: #of Tanks Pumped: Total Gallons Pumped: F V
Site Address:
Owner's Name: �}
Owner's Address(W different from site):
V
Maintainer's Name: License Number:
Private Residence: X.-j- Commercial: disposal Location:
Condition of Baffles: Type of Tanks: iz of Tanks:
Pumped Through: Effluent Sewage Discharge: Yes: No.
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.
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