3344 Sibley Memorial Hwy - Septic Maintenance Form 2012-06-26City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Email: commdevelopment c citvofeacian.com
Date Pumped:
Site Address:
Owner's Name:
Maintainer's Name:
Private Residence:
Condition of Baffles:
Pumped Through:
Comments:
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33q9
Owner's Address (if different from site):
R49 SVED
JUL 0 2 2012
SEPTIC SYSTEM MAINTENANCE FORM
# of Tanks Pumped:
k
Commercial: Disposal Location:
14
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For Office Use
Date Received:
Staff:
Total Gallons Pumped:
rA L
Type of Tanks: ,S.;:f 1 1r`
License Number:
2 (f
/Dat)
Size of Tanks:_ '2_ 61,
Effluent Sewage Discharge: Yes: No: _F3
Please submit completed forms to the Building Inspections Division via mail, fax or email.
0e s a, k Fred S�
h-e p V red n.I . fs4.rc n er74t i f c.
�P1'N � Sops off- }ra�a•�, etnt4
David Hughes
P.O. Box #21946
Eagan, MN 55121.0946