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4085 Lexington Ave - Septic Maintenance Form 2016-06-10 ---------------------- For Office use I I Date Received; City of Ea afl I Stafo: ------------------- 3830 Pilot Knob Road Eagan MN 65122 Phone:(651)676-6675 Fax: (651)675-5694 Email: commdevelopmenifi)-cityofeagan.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped. C6 #of Tanks Pumped: Total Gallons Pumped- Site Address: 9�' Z_ __7 el f1Z Owners Name.- 4C- :F- 144�te_ Owners Address(if different from site)- Maintainer:s Name: License Numt)er; "Z_�_. Private Residence- Commercial- Disposal Location: Condition of Baffles: Type of Tank-s.- Size of'Tanks: Z_50-117> Pumped Through: ,-7 Effluent Sewage Discharge: Yes- No, Comments- J;(/ Please submit completed forms to the Building Inspections Division via mail,fax or email.