1760 Cliff Rd - Septic Maintenance Form 2016-05-12 JUN-29-2016 05:31A FROM:MEYER SEWER SERVICE 6514592828 TO:6516755694 P.2/3
For Office Use--_-----_--- I
I
I Date Received: I
400 I I
City Of E�ola I Staff: C7
3630 Pilot Knob Road
Eagan MN 55122
Phone: (651)675-5675
Fax: (651)675-5694
Email: commdevelopment(a- itvofeaaan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: S �� #of Tanks Pumped: / Total Gallons Pumped:
Site Address: el- I LE ROAM E GA A
Owner's Name: J[�ly t N �F w
Owner's Address(if different from site): (� c /1
Maintainers Name: //TTF J�W t:-p o� E-R V r C _r License Number: `?
Private Residence: V Commercial: Disposal Location: S.T. -P/+V L--
Condltion of Baffles: Go D�7b Type of Tanks: L q /- /G Size of Tanks:
Pumped Through: HAlJ P a L E- Effluent Sewage Discharge: Yes: No:
Comments:
Please submit completed forms to the Building Inspections Division via mail,fax or email.