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4015 Dodd Rd - Septic Maintenance Form 2012-08-24 ►r rn r. i!'7 ~ ~ ~ ~ i4 MY FV~ ` ~ w MN W .L . ~ ~ ~4f Off'rCe U~8 ~ ~ ® ~ ~ Dats deceived: « ~ ~ ~ t f ~t~ff: I Mme. Wr~Y`~ ~ r.1~~~.M~. Y~... ~ 3$~U Pilot Knab Read Eagan MN ~51~Z ~hon~: ~55~y ~75.5G7~ F~~; ~7~~~~a9~ ~mai~: commdeve~~ ment Git o~ea an,com S~PT~~ ~Y~T~M MAINT~NAN~E F~F~M aate Pumped; ~ ~ ~ ~ of Tanks Pumped: rot~l ~~ilan~ Pum ed. >a Si#2 Address: a 4wner's~ Name: a v~ ~ ~wr~~r's Addre~~ cif di~'erent~rom site); Maintainer's Nama; ~ ~r~ I.icen~e Number; ~ j Private Residenoe~ Gornmerciaa, ~ispvsal l.oca#ion. d 1~~ CAn~i#ion of taffies: YYPe ~f ~"~nks: ,~L~]`Gt Size of Tanks; 1~~~ Pimped Through: .~1~ - Effluent Sewage Disch~r~Q: Yes; Na: Comments P~ea~e submit completed dorms tv the ~uil~ing #n~pectiQns pivi~i~n via mail, fax or email,