3070 Lexington Ave - Septic Maintenance Form 2019-01-03@cityoruasan
Date Pumped:
Site Address:
Owner's Name:
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Ii Date Received;
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I Staff
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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
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#orrankspumped Total Gallons Pumped: lC<-t<:
Owneis Address (if different from site)
Maintainer's Name:
Private Residence:
Condition of Baffles:
Pumped Through:
Comments:
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Disposal Location
Type of Tanks
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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.
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3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 625-5675
Fax: (65f) 675-5694
Email: commdevelopment@citvofeaqan.com
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SYSTEM MAINTENANCE FORM
II Date Received
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II Staff:
SEPTIC
Date Pumped:
Site Address:
Owneis Name
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Owner's Address (if different from srte)
# of Tanks Pumped Total Gallons Pumpedi Z) t;
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Maintainer's Name:
Private Residence:
Condition of Baffles:
Pumped Through:
Comments:
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Type of Tanks:
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Effluent Sewage Discharge
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Size of Tanks
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Please submit completed forms to the Building lnspections Division via mail, fax or email.