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
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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:
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License Number: 2-146 <�
Disposal Location: yw
Type of Tanks: Size of Tanks: DOO
Pumped Through: 0& 1" Effluent Sewage Discharge: Yes: No:
Comments:
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