1260 Deerwood Dr - Septic Maintenance Form 2010-09-29City of Eagan
Date Pumped:
Site Address:
Owner's Name:
Owner's Address (if different from site):
Maintainer's Name:
Private Residence:
Condition of Baffles
Pumped Through:
Comments:
9IQ /10
1 G0
c6(..)
� tt
elnr,Q Sep ic-
Tol cq cA -2
�c C Cn rr'.p —r�
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Email: commdevelopment (&,,citvofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
# of Tanks Pumped:
ci
�_. co—
________ -
Commercial: Disposal Location:
Type of Tank:
UU,k ft 6wr•._
V)Irl
For Office Use
Date Received:
Staff:
Effluent Sewage Discharge: Yes:
Total Gallons Pumped: DO ky)131,0
351z
License Number: Ur
cVt {1
Size of Tank: Ignite
No:
$.-v c.sz_ Z 1 � R € 1 .. A _o .. c r' 1-Ns: t. c _ I i e.nn
��,
Please submit completed forms to the Building Inspections Division via mail, fax or email.
•±e re-c eobu .6\ c(p3 r -1 you
you
SOLD BY
CASH
2o§
CHARGE
ON 6Gks ar
PAID OUT
QTY. /\
d \ \ DESCRIPTION \ \ \ : \
PRICE
\ \ AMOUNT
- . .
i
\ \y ,
�
. . .
� I
. /
.. . -�\
3\ »
\ /.
y
.« /
.. ..
.
.
s : % : 1w
TAX
RECEIVED BY
........
TOTAL
��. «.y.:
(«
CUSTOMER'S OR DER NO.
All claims a
o MU T be accompanied b his b
THANK BYO]
e,C-CAV COW v q ekmAtS Oq
?/1,L1 % - Nw-c-A( o 4* '2o 00cl
WaS o c' n 2A /!D
&
7R