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896 Lakewood Hills Rd - Septic Maintenance Form 2016-09-01 --------- — — -- -- — For Office Use — -- — — — Date Received ( � I Staff: City of um 1---------------------1 3830 Pilot Knob Road Eagan I&K, 55122 Phone: (651) 675-5675 Fax: (651)675-5694 Email: corr.mdevelopmentO an.com ,_cityofeaqan.co_ SEPTIC SYSTEM MAINTENANCE FORM Date Pumped:: #of Tanks Pumped: Total Gallons Pumped: Site Addrew -TsOwner's Name Owner's Address of different from site)! Maintainer's Name: %S L License Number: Private Residence. X% commercial: Disposal Location. Condibon of Baffles: c\ Type of Tanks. -;C c-- Size of Tanks: Pumped Through; Effluent Sewage Discharge. Yes, No: it Comments, IL� .�l Please sublinfli completed forms to the Building Inspections Division via mail,fax cr email.