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904 Lakewood Hills Rd - Septic Maintenance Form 2018-08-06For Office Use City of Eap ROCEIVE:1 3830 Pilot Knob Road E P III, o " a I a Eagan MN 55122 Phone: (651) 675-5675 Fax, (651) 675-5694 Email: comdevelo Inentin-iif—s— SEPTIC SYSTEM MAINTENANCE FORM Date PUMped- #of Tank- Pumped: . ...... Total Gallons Pumped 1p, Site Address: 0 0 wrer s Name 011 Owners Address (ff different from site}: Maintainers Name i /h I Lwonse Number: P -vate Residenct Oit.11osal Lo(,ation: Condition of Baffles Type of Tanks: C Size of TiMKS: Pumped Through:Mcuv,? �c)� Effluent SC,'Aaqe Discharut., Yes No: Comments: Please submit Completed forms to the Building Inspections Division via mail, fax or email,