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4420 Dodd Rd - Septic Maintenance Form 2016-05-18 JUN-29-2016 05:32A FROM:MEYER SEWER SERVICE 6514592828 TO:6516755694 P.3/3 ---------------------I For Office Use r w i 1 I Date Received: 6 I City of EandIl I Staff _ l 3830 Pilot Knob Road Eagan MN 55122 Phone: (651)675-5675 Fax:(651)675-5694 Email: commdevelopment CcDcltvofeagan.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: V �U #of Tanks Pumped: 02 Total Gallons Pumped: 15a Q Site Address: C � Owner's Name: I Owner's Address(if different from site): Maintainer's Name: 'C'r2J License Number: t, 6' Private Residence: " Commercial: Disposal Location: -• �""`-�� -re-0211 L Condition of Baffles: T t.rt�n car.�r�t J Type of Tanks: a ?)Size of Tanks: /50 U Pumped Through: �,�+Q�� "� ��-�-� Effluent Sewage Discharge: Yes: No: Comments: Please submit completed forms to the Building Inspections Division via mail,fax or email.