2745 Hwy 55 - Septic Maintenance Form 2012-06-274iks CityofEaafl
Site Address:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 6755694
Email: commdevelopment cityofeagan,com
Date Pumped: / Z" # of Tanks Pumped: / Total Gallons Pumped:
Owner's Name:
Owner's Address (if different from site):
Maintainer's Name:
Private Residence:
Condition of Baffles:
Pumped Through:
Comments:
Commercial;
SEPTIC SYSTEM MAINTENANCE FORM
Disposal Location:
Type of Tanks:
For office Use
Date Received:
Staff:
License Number: 051
Size of Tanks: / O _L]
Effluent Sewage Discharge: Yes: No:
Please submit completed forms to the Building Inspections Division via mail, fax or email,