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1244 Deerwood Dr - Septic Maintenance Form 2012-07-11Aug 10 12 08:27a Greg Gudbjartsson 952- 469 -3963 p.2 4P lifr City of Ea�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Email: commdevelopment (c� cityofeagan.com For Office Use Date Received: Staff: SEPTIC SYSTEM MAINTENANCE FORM Owner's Address (if different from site): e z Maintainer's Name: (U � G` License Number: d Private Residence: V Commercial: Disposal Location: Condition of Baffles: CO 1 Type of Tanks: l TY y Pumped Through: I' b \ i;L 4 t.e Comments: Date Pumped: 7 2— # of Tanks Pumped: I Total Gallons Pumped: Z O C G% Site Address: t -ft-1 k b'eX2(' 6eia - l`iV"E Owner's Name: E 1 d k 6 ` --,01- )4 Size of Tanks: ' .k1-@3 Effluent Sewage Discharge: Yes: No: Please submit completed forms to the Building Inspections Division via mail, fax or email. z, Cn