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
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Date Received:
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I Staff:
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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.