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4730 Dodd Rd - Septic Maintenance Form 2018-07-2841kol CityEakanof 3830 Pilot Knob Road Eagan M N 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: co mmdevelopmentPcityofeagan com --------------------- For Office Use I I � Date Received: I I � I I I Staff: I SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: _ ,1 1;."/ II V # of Tanks Pumped: 2 Total Gallons Pumped: Z 1 00© Site Address: Owner's Name: Owner's Address (if different from site): Maintainer's Name: -Sc'_-t4ioo✓ i „S' V Vic f S License Number: Private Residence: Commercial: Disposal Location: P -77Z& Condition of Baffles: (fP✓ (jJ wri Type of Tanks: Stip'rt C- Size of Tanks: /, 670o Pumped Through: P ^ Effluent Sewage Discharge: Yes: No: ✓ Comments: Please submit completed forms to the Building Inspections Division via mail, fax or email.