810 ONeill Dr - Septic Maintenance Form 2017-07-12 ----------------------
For Office Use
RECEIVED I I
Date Received: I
City of Eayn ll I Staff: I
I I
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3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651)675-5694
Email: commdevelopment(&cityofeactan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: 7r S� I #of Tanks Pumped: Total Gallons Pumped:
Site Address:
Owner's Name: J R--
Owner's Address(if different from site):
Maintainer's Name: License Number:
Private Residence: x Commercial: Disposal Location:
C
Condition of Baffles: r�6 Type of Tanks: Size of Tanks:
Pumped Through: Effluent Sewage Discharge: Yes: No:
Comments:
Please submit completed forms to the Building Inspections Division via mail,fax or email.