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985 Cliff Rd - Septic Maintenance Form 2017-08-16 --------------------- ��,,� � For Office Use �7 � ID I Date Received: RECEIVED City of E� aIl I Staff: __ 3830 Pilot Knob Road Nl�� 18 1017 — Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment(&cityofeagan.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: �A140--] #of Tanks Pumped: Total Gallons Pumped: O G e Site Address: GVr,1<7' ��1" 'GEC P e. n Owner's Name: �` k�.ti C .�?�,,� •� _�D �i� L�A� 4.17g� Owner's Address (if different from ``__silte)):" Maintainer's Name: C,f `6�►�[ndy 6cruius License Number: Private Residence: - Commercial: Disposal Location: Y�lei+ Condition of Baffles: V Type of Tanks: 5- n U Size of Tanks: 1 T ©o Pumped Through: mk,t 1fL )F'!$ � J ,Effluent Sewage Discharge: Yes: _ No: Comments: Please submit completed forms to the Building Inspections DtV,3 iDn via mail,fax or email.