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3305 Lexington Ave - Septic Maintenance Form 2017-09-19Ci*ty of Ea aIl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment(cbcityofeagan.com --------------------- For Office Use Date Received: 10 /2p I Staff: III SEPTIC SYSTEM MAINTENANCE FORM Date Pumped:qh # of Tanks Pumped: L Total Gallons Pumped: q I Site Address: Le K't A Owner's Name: Owner's Address (if different from site): Maintainer's Name: 5cl shite/): 1)2, Private Residence: Commercial Condition of Baffles: ��Xu; J Cs.k-s License Number: 2-146 <� Disposal Location: yw Type of Tanks: Size of Tanks: DOO Pumped Through: 0& 1" Effluent Sewage Discharge: Yes: No: Comments: Please su 2. a - — M E M 0 Ch 0 W-4 Z D Cn cr) C) IR W L0 �d E "csZ Qr- < Ij Z I E 0 C-> Cl At 0 G Z 0(\j 0 W .., 9 LU < Lo < C) IS 0V Lo 4-- cc cu CD 'S Llo E LO Ti •E CZ M LO co E LL. t to co U) Uj W W 0 (r < 0W 0U) Z < < IT > < W Cc