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3325 Lexington Ave - Septic Maintenance Form 2016-04-08 I -------------------- E Clt of � Date Received: I I I Staff I 3830 Pilot Knob Road i ----- Eagan MN 55122 -------- ---------I Phone: (651)675-5675 Fax:(651)675-5694 Email: commdevelo ment(aklr�.,se _ om SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: __ #of Tanks Pumped Total Gallons Pumped: _ /(JUO Site Address: 33 oZ.S �C k r to(q ,�� Owner's Name V S Owner's Address(if different from site): Maintainer's Name �p i License Number: _1 LO(oS- Prrvaie Residence: �` Commercial: Disposal Location: Condition of Baffles: Type of Tanks: �N(-XP f, Size of Tanks: U Comments: Pumped Through: —_ K.►�to�,t e T�-- Effluent Sewage Discharge. Yes - No: Please submit completed forms to the Building Inspections Division via mail,fax or email.