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830 ONeill Dr - Septic Maintenance Form 2021-12-01EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 I FAX: (651) 675-5694 Plan Submittal: eolans(a cityofeagan.com Date Pumped: (,Site Address: Owner's Name: For Office Use Date Received: Staff: SEPTIC SYSTEM MAINTENANCE FORM op ti, vizi Total Gallons v 1/# of Tanks Pumped.. ��Q D I'" )3APumped: p- 8N,30 d 'AV D r v Ef Q'1,1 i!4 // 5 /z 1-- /539 -1-1 /1-&ty Ali Owner's Address (if different from site): Owner's Email: n0-1 0/-4.C" /nsn.(rrv) Maintainer's Name: X ° St fat. C Private Residence: Commercial: Disposal Location: ,SlititeA) Sueict. Owner's Phone #: Condition of Baffles: LuA n t Y\ Pumped Through: 5t(Amd Comments: License Number: .SJ - 5-7Z L 9/s %Spt1L Type of Tanks: 2, et /Li/001S Size of Tanks: Effluent Sewage Discharge: Yes: /M O I.Cln No: bob j4dlifd 4,wi' JA_Dict..) pevry ' -3 Lv I fia !u, .'u 'tam, I)tL4 L hid-zi- 30 r Name of Person Completing Form: .,4ft D -a Date: 14/Z Z You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. Please submit completed forms to the Building Inspections Division via mail, fax or email.