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.