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4015 Dodd Rd - Septic Maintenance Form 2017-06-12City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment(o�cityofeagan.com Date Pumped: Site Address: Owner's Name: RECEIVED JUN 1 3 2016 For Office Use Date Received: la 13 / 17 Staff: SEPTIC SYSTEM MAINTENANCE FORM (3(..c.- 12 - # of Tanks Pumped: Total Gallons Pumped: L ®\S` cocMct i\AyY ()ct"s o v Owner's Address (if different from site): Maintainer's Name: f,Si7 T( C License Number: 9c/ Private Residence: x Commercial: Disposal Location: Condition of Baffles: ? 74 Type of Tanks: g L Size of Tanks: 10e Pumped Through: /2 7 (Air (?v i l( Effluent Sewage Discharge: Yes: No: ( Comments: Gc42C( Cc='11c4p -t Please submit completed forms to the Building Inspections Division via mail, fax or email. SCHLOMKA'S VAC TRUCK SERVICE INC. No. 2403 (651) 437-7284 • FAX: (651) 437-9405 CUSTOMER: NOVA DATE: ao - `'L- i '"} JOB LOCATION: L4 -r I c "Dacia Q...0 E/ /jam" MN P.O. #: WORK COMPLETED: U Cc) W.O. #: EQUIPMENT USED: HOURS c is oect oc - -' cA DESCRIPTION OF WORK: PRINT NAME & SIGN yRa 0/1/ /1//r, Customer's Agent GDI No. 82829 6/2011 Aug 1717, 02:12p Schlomka's Vac Truck City of Wall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675.5694 Email: commdevelopment(a�cityofeagan.com 651-437-9405 p.2 For Office Use Date Received: U 1 t S / �1 ` Staff: SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: sC ' - 2_on # of Tanks Pumped: Total Gallons Pumped; 2- vw Site Address: 40.c, JQ oci6 t a o . cy,A4 t v% A,vk Owner's Name: 0/1 l ovk v_ .5 Owner's Address (if different from site): Maintainer's Name: Sc L Owi(( O PVTU- G License Number: 02_ Private Residence: Commercial: Disposal Location: �'.30 S `2/ Q Size of Tanks: V1/43013 Condition of Baffles: Type of Tanks: Pumped Through: Y "/ 1 6 -AA - \A/CAF_ Effluent Sewage Discharge: Yes: No: X Comments: Please submit completed forms to the Building Inspections Division via mail, fax or email.