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2750 Lexington Ave - Septic Maintenance Form 2012-07-05City otEaoan 3830 Pilot Knob Road Eagan M N 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Email: commdeve lopment(ccityofeactan.corn SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: " 7 — r # of Tanks Pumped: Total Gallons Pumped: 0 Site Address: 'A Lex 1Yv--011 Owner's Name: Owner's Address (if different from site): Maintainer's Name: Private Residence: Condition of Baffles: Pumped Through: Comments: (-6 h'l� ,r Cau.+rI-e,t'.. S11Ior\ uil Commercial: 7fV i L&k e� For office Use Date Received: Staff: License Number x01 K`1 Pang 1 ( e71 -D Type of Tanks: �` lc + n Size o` Tanks: apt ✓ Disposal Location: vnl ri Effluent Sewage Discharge: Yes: Please submit completed forms to the Building Inspections Division via mail, fax or email. No: L'""`