975 Cliff Rd - Septic Maintenance Form 2017-05-10 JUL-16-2017 12:03P FROM:MEYER SEWER SERUICE 6514592828 TO:6516755694 P.2{5
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For Office Use I
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of Wan Clt t Staff: I L-----------------
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651)675-5694
Email: commdeveloament(&cityofeaaan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: I #of Tanks Pumped: Gallons Pumped: 0
Site Address:
Owner's Name:
Owner's Address(if different from site):
Maintainer's Name:
AC41 -
G License Number:
Private Residence: ✓ Commercial: Disposal Location:
Condition of Baffles:
yam/ Type of Tanks: L Size of Tanks:
Effluent Sewage Discharge: Yes: No: 1/
Pumped Through:
Comments:
Please submit completed forms to the Building Inspections Division via mail,fax or email.