660 Lone Oak Rd - Septic Maintenance Form 2012-09-26•
•
City of
3830 Pilot Knob R
Eagan MN 55122
Phone: (651) 675 -5 »75
Fax: (651) 675 5691
Email: commdevel
tan
Date Pumped:
Site Address:
Owner's Name:
Owner's Address Of different
Maintainer's Name:
Private Residence:
Condition of Baffles:
Pumped Through:
Comments:
i/
pme nta,cityofeagan. com
For Office Use
Date Received:
Staff:
n
SEPTIC SYSTEM MAINTENANCE FORM
# of Tanks Pumped:
1 Total Gallons Pumped: 200
4P0 \oe_ Qa rr.9
om site):
rasenbeTr
Commercial:
(419
Schtornvou
Disposal Location:
((. Type of Tanks:
PiPed
SLt e se Number: c&,cc
M ' s± . eckAA t�tnit?
(.r' Size of Tanks: goo
Effluent Sewage Discharge: Yes: No:
Please subm
t completed forms to the Building Inspections Division via mail, fax or email,
•
Goo Loa Oot-�- R�
ti. City of Calan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5660
Fax: (651) 575-5694
Email:ommdevelo ment@ci ofea an.com
RESIDENTIAL RENTAL REGISTRATION
% 1114/1-5
Either a property owner or rental manager shall register all residential rental properties with the City of Eagan. in the case of
a transfer of ownership, change in rental manager, change in the number of rental units or change in dwelling occupancy
from owner occupancy to rental tenant occupancy, the property owner or rental property manager shall complete and submit
a registration form for every property affected by the transfer within thirty (30) days of the transfer.
Please complete one registration form for each residential rental property address.
Check one of the following that applies:
® New Rental Registration
❑ Change of address/phone number
❑ Change of owner
❑ Change of rental manager
❑ Change in number of units
❑ Change from owner to rental occupancy
Page 1 of 2
Gregg Rosenberger
Name:
522 14th Avenue North
Address Number/Street:
APPLICANT/
REGISTRANT ,
City, south st. Paul State: MN Zip: 55075
Primary Phone: 651.785.6355 Altemate Phone:
greggsautobody@hotmail.com
Email:
RENTAL
660 Lone oak Road 55121
Address Number: Street: Zip:
PROPERTY
INFORMATION
1
Number of Rental Units. Building Name (if applicable):
Gregg Rosenberger
Name:
522 14th Avenue North
Address Number/Street:
PROPERTY
OWNER
south st. Paul MN 55075
City: State: Zip:
651.785.6355 651.774.8211
Primary Phone: Alternate Phone:
greggsautobody@hotmail.com
Email:
SEE REVERSE -3
Page 1 of 2
QUESTIONS
(a6D LovtrL Oak P.o4
A rental manager is reguired. A rental manager is any person who has been delegated by the
residential rental property owner with the charge, care or control of a residential rental property and
is able to respond in-person to issues related to the residential rental property. The rental manager
may be the same as the owner and/or applicant.
Name: Renters Warehouse/Brenton Hayden
Address Number/Street: 6101 Baker Road #200
City_ Minnetonka state: MN Zip: 55345
Primary Phone: 952.470.8888
Email: jzupfer@renterswarehouse.com
Alternate Phone: 952.224.9911
Any person providing false information on the prescribed registration form shall be guilty of a
misdemeanor and subject to a fine.
1. Does the residential property owner or rental manager conduct a criminal background check on
each and every residential tenant?
13 Yes 0 No
2. Does a written lease exist for each and every residential properly and unit dwelling thereon?
® Yes la No
3. Does a written lease addendum commonly known as "Drug Free/Crime Free Lease Addendum"
exist for each and every written lease?
® Yes 0 No
After completing the Residential Rental Registration form In Its entirety, submit It electronically to
commdeveloomenrt cirvaieaoan.co.. , fax to (651) 675-5694 or deliver to:
Eagan City Hall
Attn: Community Development
3830 Pilot Knob Road
Eagan, MN 55122
Page 2 of 2
CERTIFICATE OF RENTAL REGISTRATION
This certificate verifies that the below property is registered as a residential rental
Sarah Brandel, Office Supervisor
Department of Community Development
Signed:
1
Number of Units:
City of Eagan
55075
property within the City of Eagan.
Renters Warehouse
Rosenberger
MN
55121
Lone Oak Rd
,
14th Ave NSouth St. Paul
1/19/2016
MN
,
Eagan
Gregg
January 19, 2016
660430
Property Owner:Manager:
Site Address:
Rental
Date: