4640 Dodd Rd - Septic Maintenance Form 2017-05-03 JUL-16-2017 12:04P FROM:MEYER SEWER SERVICE 6514592828 TO:6516755694 P.5.5
For Office Use
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I Date Received:
City of Ea�d I staff:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651)675.5675
Fax: (651)675-5694
Email: comm dove lopment(&cityofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: v -7 #of Tanks Pumped; J Total Gallons Pumped: 19000
Site Address: '`TCo7� /✓ /L(.0 &2 , 222z.2
Owner's Name: & aM a,,
Owner's Address(if different from site):
Maintainer's Name: License Number.
Private Residence: Commercial: Disposal Location: Z&,
Condition of Baffles: -7,,/, 6-u r Type of Tanks: � ��nat�r-icJ _ Size of Tanks: 5 l00 o
Pumped Through: r q- Effluent Sewage Discharge: Yes: No:
Comments:
Please submit completed forms to the Building Inspections Division via mail,fax or email.