4980 Dodd Rd - Septic Maintenance Form 2016-06-02 ----__----------------
For Office Use
_J, I '/CVE Date Received: I
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City of Ea an JUL 1 1 201
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3830 Pilot Knob Road
Eagan MN 55122
Phone: (651)675-5675
Fax: (651)675-5694
Email: commdevelopment(&cityofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: C)i:�, 0 - 9' �k #of Tanks Pumped: ` Total Gallons Pumped: ICS c..
Site Address: I 1 gjC) b nAA V�
Owner's Name: �� �i v
Owner's Address(if different from site): -�
Maintainer's Name: 1> CL&V%nuo i X04 Se-'r U C.A.- License Number:
Private Residence: Commercial: Y- Disposal Location:
Condition of Baffles: Type of Tanks: Size of Tanks:
Pumped Through: Effluent Sewage Discharge: Yes: No:
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.
Aida Indusiries, Inc.
PO Box 767 THANK YOU....WE APPRECIATE YOUR Invoice# 202143
Lakeville MN 554
BUSINESS!
Date 6/6/2016
www.bspg Wing.com
Midwest Starz f Due Date
3658 120th St W
Rosemount MN 55068 6/21/2016
Date of Service Description Amount
-&2?W16 --- c em Pum &M entul-Dis 265.00
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4980 Dodd Rd
6/6/2016 Septic Tanks Inspected&Pumped as Required&Metropolitan 305.00
Environmental Disposal Fee @ 3658 120th St W
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Disposal @Empire WWTP , bow I Total $500.00
For Qucastions about your invoice or Septic System Please Call: 952-469-2573 or 651-460-8015.
You may also Email us: info @bspumping.com
Remove lower portion and remit with payment
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