4135 Lexington Way - Septic Maintenance Form 2015-11-10Dec 14 15 01:33p Greg Gudb,jartsson 952-469-3963 p.2
RECEIVED
DEL 14 2015
CityEaEdof �
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: commdeveio ment cit ofea an.com
Date Pumped:
Site Address:
Owner's Name:
— _ — ^
For Oce Use
Office I
I I
I
Date I Deceived,
I I
I _ _I
1 Staff: I
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SEPTIC SYSTEM MAINTENANCE FORM
# of Tanks Pumped: Total Gallons Pumped:
Owners Address (if different from site):
Maintainer's Name: l/�@sjL+�� License Number:
Private Residence: Commercial: _ Disposal Location:
a
Condition of Baffles: Type of Tanks: Size of Tanks:
Pumped Through: Effluent Sewage Discharge: Yes: No: _
Comments:
Please submit completed forms to the Building Inspections Division via mail, fax or email.