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1350 Rocky Lane - Septic Maintenance Form 2018-05-16_ r ;.. City of Eap 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Email: commdevelopment<a*citvofeaaan com For Office Use — I I I I I Date Received: I I I Staff: I I --------------------- SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 6--/1 ) V Site Address: z J ® C Owner's Name: SA e Owner's Address (if different from site): Maintainer's Name: 22 # of Tanks Pumped: Z Private Residence: Commercial: Condition of Baffles: Pumped Through: 1 �G.v�� J e— Comments: IA Total Gallons Pumped: , S' a License Number: Disposal Location: /' ' e Type of Tanks: e0�1 Size of Tanks: S TJ C3 Effluent Sewage Discharge: Yes: No: Please submit completed forms to the Building Inspections Division via mail, fax or email.