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863 Lakewood Hills Rd - Septic Maintenance Form 2018-08-17Eagan MN 55122 Phone: (651)675-5675 Fax: (65.1) 675-5694 Email: e=ommdevelopment@citvofsaqan.com SEPTIG SYSTEM MAINTENANCE FORM Owne/sAddress (tfd fere.t rrom site): schlo^<n L,cense Numbe, Zqgc t-/"" ^.". # orranks pumped: @ Z roraica,ons pumped, /EJl Effueni Sewage D scharge yes Condition of Bafiles abA-+ lUaa lvl* rype ofranks (epltC size orranks Please submit compteted forms to the Buitding tnsp€ctions Division via mait, fax or emait. I Slaft: - ---- -----___-___l