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4900 Dodd Rd - Septic Maintenance Form 2020-09-16-------------------- For Office Use I . I city Of I,'(1 I Date Received: I I I 3830 Pilot Knob Road I Staff: I � I Eagan MN 55122 -------____— I Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelo ment cit ofea an.com SEPTIC SYSTEM' MAINTENANCE FORM 1lDate Pumped: � 6 i # of Tanks Pumped: qj /'t j Total Gallons Pumped: r G Site Address: ` (�/ � 259 Owner's Name: ° Owner's Address (if different from site): Maintainer's Name: Private Residence:License Number: gq Commercial: Disposal Location: Condition of Baffles: Type of Tanks: Size of-Tanks: ✓�f� Pumped Through: ` Effluent Sewage Discharge: Y Comments: D � es: No: kj Please submit completed forms to the Building InspectionsaDivision via mail, or email: