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4775 Dodd Rd - Septic Maintenance Form 2017-05-20 RECEIVED ------ -------------I For Office Use JUN 0 5 2016 Date Received: nn 400 City of Ea pall I Staff I— — —- 3830 Pilot Knob Road ———--- —— Eagan MN 55122 Phone: (651) 675-5675 Fax: (651)675-6694 Email: commdevel SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: -7 4 of Tanks Pumped: Total Gallons Pumped: 000 Site Address: 7 7 S 00A Owner's Name, (.)U— Owner's Address(if different from site): Maintainer's Name � �-JY License Number: Private Residence: Commercial: s^ Disposal Location: —:R ILA-g— LAew Condition of Baffles: C Type of Tanks: Size of Tanks: Z -2(jo Pumped Through: L Effluent Sewage Discharge: Yes, No: Comments: Please submit completed fog ms to the Building Inspections Division via mail, fax or email.