4045 Lexington Ave - Septic Maintenance Form 2020-10-29City of Pa fan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: commdevelo ment cit ofea an.com
Date Pumped:
Site Address:
Owner's Name:
-e
For Office Use
Date Received:
Staff:
------------------- -1
SEPTIC SYSTEM MAINTENANCE FORM a
_______02____
# of Tanks Pumped:
Total Gallons Pumped:'
1 � .
Owner's Address (if different from site):
Maintainer's Name:
Private Residence:
Condition of Baffles:
Pumped Through:
Comments:
Mi-
Commercial:
Disposal Location:
Type of Tanks:
License NQmber:
Size of Tanks:
Effluent Sewage Discharge: Yes:
Please submit completed forms to the Building Inspections Division via mail, fax or email.
No:
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