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3070 Lexington Ave - Septic Maintenance Form 2019-01-03@cityoruasan Date Pumped: Site Address: Owner's Name: I ;;o".;,r"; Ii Date Received; I I I Staff I 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (551) 675-5694 Email : com mdevelopme nt@citvofeaqan. com SEPTIC SYSTEM MAINTENANCE FORM tlSif t? #orrankspumped Total Gallons Pumped: lC<-t<: Owneis Address (if different from site) Maintainer's Name: Private Residence: Condition of Baffles: Pumped Through: Comments: J"n*rJ,:,), x LutL-lui\uvt Disposal Location Type of Tanks N'w,rr.. 7 License Number: ,7q Qq size of ranks: I C C'C No: 2(Effluent Sewage Discharge Yes Please submit completed forms to the Building lnspections Division via mail, fax or email. ffiityoffiagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 625-5675 Fax: (65f) 675-5694 Email: commdevelopment@citvofeaqan.com t_ SYSTEM MAINTENANCE FORM II Date Received I II Staff: SEPTIC Date Pumped: Site Address: Owneis Name \ t\r Owner's Address (if different from srte) # of Tanks Pumped Total Gallons Pumpedi Z) t; U1t) V6 tt:h.r,u {\.,a Maintainer's Name: Private Residence: Condition of Baffles: Pumped Through: Comments: -f commerciat Disposal Location: Type of Tanks: ..) Effluent Sewage Discharge ..) Size of Tanks Yes ruo, { Please submit completed forms to the Building lnspections Division via mail, fax or email.