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,