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1436 Highview Ave - Septic Maintenance Form 2021-05-04City of Ea an 3830 Pilot Knob Road Eagan M N 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: cornmdeveioprnent@eityofeagan.com For Office Use Date Received: Staff: SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 5 " / # of Tanks Pumped: Site Address: ) "-) (0 / h v s,w A Owners Name:{[ {.i'1 P i / f o r Owner's Address (if different from site): Maintainer's Name: Private Residence: Commercial: Condition of Baffles:od Pumped Through: li' [“) /46 / ? Comments: Disposal Location: Total Gallons Pumped: -S/2i. License Nurnber: / oo Type of Tanks: �'� Size of Tanks: WOO 94IS Effluent Sewage Discharge: Yes: No: Please submit completed forms to the Building Inspections Division via mail, fax or email.