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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 --------------------- For Office I I I I Date Received: i I Staff: --------------------- � 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.