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.