520 Lone Oak Rd - Septic Maintenance Form 2012-05-23City of Eapu
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 615 - 5694
Email: Comm Ieve!opmentecitvofeaQan.com
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Owner's Address (if different from site):
Maintainer's Name:
Prfvafs Residence: Commercial:
Condition of Baffles:
Pumped Through: PAP'
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Comments:
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5 ( v 10%. Jr"' y L2
Disposal location:
For Office Use
SEPTIC SYSTEM MAINTENANCE FORM
Type of Tanks: se. Size of Tanks:
Date Pumped: ✓ ° Z 3. ) # of Tanks Pumped: j Total Gallons Pumped: /17 iV 2
Site Address:
Owner's Name:
License Number. ill?
Effluent Sewage urge: Yes: No:
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Please submit completed forms to the Building inspections Division via mail, fax or email.
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