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4135 Dodd Rd - Septic Maintenance Form 2021-12-27License Number° r2q iq Commercial: Disposal Location: E r'Y1 f],fec - � a �• e �.� ,� Tai.{mtn ,7 y "` f( �� r'� T r crlrr lajcriO N Size of Tanks: 1A e d 94-if Effluent Sewage Discharge: Yes: ° No• y �lr+ Type of Tanks: City of Eaall 3830 Pilot Knob Road Eagan M N 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: cornmdevelopment@cityofeadan.com For Office Use Date Received: Staff: SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 12 -"a 7-7/ # of Tanks Pumped: � Total Gallons Pumped: 1/00 Site Address: _ Y13 5 O W Rei S S 1 Z.3. . Owner's Name: oPrid6t./e u p I [� t/i'if'f Owner's Address (if different from site): r Maintainer's Name: .P Private Residence: Condition of Baffles: Pumped Through: Comments: yvi u-JiV' k Please submit completed forms to the Building Inspections Division via mail, fax or email.