965 Cliff Rd - Septic Maintenance Form 2015-07-29 —ForOfgcet�xeT-- -- --------I
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: .� `l y 1 Date Received:.
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3830 Pilot Knob R*od
Eagan MN 55122
Phone:(651)6757x.
l=ax:(651)675-5694
Email:c mrndevelea men it ofe a an_com
SEPTIC SYSTEM MAINTENANCE FORM
Cate pumped: — G — J-- #of Tanks Pumped.- 1 Total C3aiions Pumped:
Site AOdress- — d 'r-
oym$eg flame:
Owner's Address(if O fferMt*OM site)' }, _
Maintainers Tlartte: � �+ s Zj� b S �u.fIM3�'t_" License Numbet,
Prnrate Residenoe: /- Gommemw: Disposal LaotiW
Crnditian of BaNes: -type QfTanks: — Size of Tanks
Pumped Through: Efflant Sewage Discharge: Yes-
Comments;
Please submit completed foams to the Building Inspections Division Via mail,fax or email:.