820 ONeill Dr - Septic Maintenance Form 2017-06-14 JUL-16-2017 12:04P FROM:MEYER SEWER SERVICE 6514592828 TO:6516755694 P.4/5
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For Office Use
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Date Received:
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City � I of I Stan:_
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3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651)675-5694
Email: commdevelopment(cDcitvofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: / #of Tanks Pumped: Total Gallons Pumped.
Site Address:
Owner's Name'
Owners Address(if different from site):
Maintainer's Name: ) ) t°.QJ License Number:
k or
Private Residence: ✓ Commercial: Disposal Location.
Condition of Baffles: !r'fit.7�/ Type of Tanks: lz::Iye�C Size of Tanks: 1500
Pumped Through: � �idjpf. ) Effluent Sewage Discharge: Yes: No:
Comments.
Please submit completed forms to the Building Inspections Division via mail,fax or emall.