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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: