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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: / . L 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 A AA (-as: 3399 S:61e. Aqa� p1e�or�`gI 44 I M7 SriZ Cal.4n j4ert .4r 5 er 4 ?'- p ► �.� 5'1 SJgv-e', and. ( 0) 2 O M • I41.r b Wite. i$. lei ` ',' h; z .{) k ► s ( - f 3'7 - /(c 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