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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: •