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1215 Diffley Rd - Caponi Art Park - Septic Maintenance Form 2016-10-05 --------------------- For Office Use I I I Date Received: City of Eap I I Staff: I 3830 Pilot Knob Road --------------------1 Eagan IVIN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment(cDcitvofeaoan.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 'Q)— 5- Z � #of Tanks Pumped: 1i Total Gallons Pumped: Site Address: Owner's Name: (� �y Owner's Address(if different from site): I Maintainer's Name: r�C}��,C�C }25 License Number: Private Residence: Commercial: Disposal Location: mp\rte W7 S Condition of Baffles: Type of Tanks: Size of Tanks: Pumped Through: Effluent Sewage Discharge: Yes: No: ,n Comments: Sow 7Y RlcArk ',�A Esc. l*rN CWT `motto r\" Please submit completed forms to the Building Inspections Division via mail,fax or email. dso ZLPA-;<- '-•nom ` h�� sl�. `'k" L-kt1ynow(\ �5 er hc)nef- :3� 1 coo ? - Canty P,or k- 4and i5 6VLj ap' anted yr