830 ONeill Dr - Septic Maintenance Form 2017-05-17 ---------------------
For Office Use
I I
Date Received: I
City of EaEd� i Staff:
_____________________
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651)675-5694
Email: commdevelopment(&-citvofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: Ll 7 b #of Tanks Pumped: 3 3ooy
Total Gallons Pumped:
,y � /�1
Site Address: 2J Q V A `P—! 11 c 5
Owner's Name: �y�U S V Ale t L
Owner's Address(if different from site): C'
Maintainer's Name: /0 e / "ate 7 �Y V License Number:
Private Residence: Commercial: Disposal Location: PAL,/
Condition of Baffles: VA,4"' /0141AI Type of Tanks: 5°r. p- g-"p 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.
JUL-16-2017 12:03P FROM:MEYER SEWER SERVICE 6514592828 T0:6516755694 P.3/5
---------------------
For Office Use
� I
Dale Received.
City of Ea ��� I Staff:_ I
--------------------i
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651)675.5694
Email: commdeveloument _)citvofeaAan.com
SEPTIC SYSTEM MAINTENANCE FORM
Dale Pumped: S11-7 #of Tanks Pumped: Total Gallons Pumped: 20 O O
Site Address: C.7 s o
Owner's Name
Owner's Address(if different from site):
Maintainer's Name: / , ) �� License Number•
Private Residence: ✓ Commercial: Disposal Location'
Condition of Baffles, 7.�r.Fnc s(..-7L1 Type of Tanks: Z�„ -epeLr,L 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.