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4085 Lexington Ave - Septic Maintenance Form 2015-05-15 r � For--- Use ------------ i '> I Date Received; l City of Eajan I stat . 3830 Pilot Knob Road Eagan WIN 55122 Phone:(651) 67645675 Fax:(651)676-5694 Email:cornrndevelopment _d1yofeaclari.carn SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: �, .�.. #ofTanks Pumped_ _ Total Gallons Pumped; Site Address: .. t er's Narna: �i 1 P ' Z112j,, [ Owner's Address(if different from site)-. Maintainer's Name. .r °, l=icense Number. Private Residence- _ Commercial: Disposal Location: Condition 015afnes: Type of Tanks: __ Size of Tanks: /z f!C2 Pumped Through: � r Effluent Sewage D'rs barge. Yes: ---_ No: Comments: Please submit completed forms to the Building Inspections Division via mail,fax or email-