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3083 Sibley Memorial Hwy - Septic Maintenance Form 2018-08-17I ,,,.,,[,ll.r_f"l,uu, Eagan MN SS122 Phono: (651) 675-56 s Fax: ( 5l) 67;"s6s4 f;;or'.;u* I Email: commdeveloprhent@citvofeaqan.com SEPTIC SYSTEM MAINTENANCE FORM Tolalcallois pumpedl zooo I lh*t Owners Addrcss (rf ditrerent trom site) lr/ ""^^",",,"' LicenseNumbe, 2491 L,v,kno.n ryp6 of ranks Luknoun PIP" Erfluent sewase Discharse Please submit compteted forms to the Buitding tnspections Division via mait, fax or emait. --- - --- ------ -_-____l