874 Lakewood Hills Rd - Septic Maintenance Form 2020-09-232014-07-12 01:06 » P 111
40� City of EaFn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: co dev to m cit a a .corn
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For Office I
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Date Received: i
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Staff:
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SEPTIC SYSTEM MAINTENANCE FORM
Dale Pumped; �\ 2 - Zo a of Tanks Pumped: p Total Gallons Pumped; 000
Site Address: �� y
Owner's Name: 4 �� 7 k as
Owner's Address (if different from site):
Maintainer's Name. ��i✓rs S �fiL `g L
License Number;
Private Residence; __z Commercial: Disposal Location:_
Condition of Baffles: _ Type of Tanks:
Size of Tanks: iGz
Pumped Through: Effluent Sewage Discharge: Yes: No; 1f
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.