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578 Michigan Ct - Septic Maintenance Form 2020-09-172020-09-22 17:05 LaRoche's Sewer 555 555 5555 » P 1/1 411,11 CityofEa�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopmentpcitvofeagan.com For Offlco Uso Oj Date Received: Staff: L SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: - 1 — 19 — aQ # of Tanks Pumped: a- Total Gallons Pumped: I) 10 Site Address: 5 1 M I Gtt 1 Q G1,ir1 wl11.- t Owner's Name: BolD 1 a_h_o Jn e �( Owner's Address (if different from site): Maintainer's Name: LD QCkR S S-e—tA X :tiro T.\ E Secii License Number: �O Private Residence: Commercial: Disposal Location: —C.1/4 G cl a' Secrki L /000 Condition of Baffles: r\c4 r1 Type of Tanks: Q u J \0. .t. + Size of Tanks: Pumped Through: U1 eC-kihn p l S Effluent Sewage Discharge: Yes: Comments: No: Please submit completed forms to the Building Inspections Division via mail, fax or email.