925 Cliff Rd - Septic Maintenance Form 2020-07-05EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 I FAX: (651) 675-5694
Plan Submittal: eplans a�citvofeacian.com
Date Pumped:
Site Address:
Owner's Name:
For Office Use
Date Received:
Staff:
SEPTIC SYSTEM MAINTENANCE FORM
�-2,0 # of Tanks Pumped:
�)s
2-
Total Gallons
Pumped:
b
fx)AiD6 A.).c),41 TATimis ric.1
Owner's Address (if different from site):
Owner's Email: G.4,1 SA B S v C. ,,n
Maintainer's Name:
ft,.114a�
JJ J
Owner's Phone #: % 17— 432— Z )
Seti•if-g- gli- I cvc License Number: I 3
Private Residence: x Commercial:
Condition of Baffles: /
(,'� LAC,
Pumped Through: M.( L- 5
Comments:
Disposal Location:
Type of Tanks:
1\16T et 11_ PLA"%IT
Size of Tanks: lb t jek
Effluent Sewage Discharge: Yes: No:
Name of Person Completing Form:
Ts
Date:
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Please submit completed forms to the Building Inspections Division via mail, fax or email.