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706 Lone Oak Rd - Septic Maintenance Form 2021-05-04City of Ea�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment{c�citvafeagan.com For Office Use ❑ate Received: Staff. SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: '/"Y ! 2 I ## of Tanks Pumped: 1 Total Gallons Pumped: / S 6 b Site Address: .-7 ()c (6'k OaK K k r) E &'j &, 7/J S5?.?-/ Owner's Name: ,J Ohin 1/0rY12 /.� Owner's Address (if different from site): Maintainer's Name: License Number: c2q 9R Private Residence: _ Commercial: Disposal Location: ��i�ll�� �Css�� �� Tod-film-F(4m+ of Baffles: (An Lnbto Type of Tanks: Size of Tanks: ), CO° ^� Pumped Through: Effluent Sewage Discharge: Yes: No: V Comments: Please submit completed forms to the Building Inspections Division via mail, fax or email.