885 Lakewood Hills Rd - Septic Maintenance Form 2020-10-08 ---------------------
� sarofrk.tn. �
EAGAN '
. .. .. ; o,xeRek.
� ed
I
-- I Std.
---------------------I
3830 PILOT KNOB ROAD I EALAN ktN SS I u-1610
{6511675-56151 FAX (651)615-5694
Plan Submittal.opglflj Mo%apall-cpm
SEPTIC SYSTEM MAINTENANCE FORM
TOW Go
Date Pumped. `Up/,9/a0 _._.. Yof Tanks Pumped P /urnpow�,y,�/ ��d'�L�-__ _
Site Address: CJ o yr'�-x-K+i /C_yT-�a.��
Owner's Name:
Owner's Address it different from saw
Owner's Eme4 _ Owners Phone M. . � /_-.lsr�_
Melntarer s Name. _% / .L.D.LiI 1h 1Jx^"�'r� eR�Ufc/a�ln�saNuu�mber. 91 T
Private Residence: r/ C Ill Disposal Location: r
Condition of Bames: $ /'PW ee.__ Type of Tants: fiAip r, d Tanks:
Pumped Through: - LC r1 _ Fill $swage mii: Yes: No.
Comments:
Nemo of Pinson Ctngletng F Date: holg O
You may subscribe to receive on electrode notification fran the Gty of proposed ordinances by signing up for an email update
on the City's website at www.cttyoledg"r9ot'lubaLtlhe.
Please submit completed forma to the Building Inspections Division via mail,fax or email.