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4135 South Robert Tr - Septic Maintenance Form 2017-05-09 Ju1. 06.2017 04 :47 PM Valley Blacktopping, Inc. 6514523220 PAGE. 2/ 6 --------------------- For Office Usa I I I Data Received:, City of Ea a� I I Staff: _ 3630 Pilot Knob Road Eagan Mtn 55122 Phone: (651) 676.5675 Fax: (651)675-5694 R E � C a Email: commdevelopment ltyofea-gan.com .€ -- — JLII. 0 6 2017 SEPTIC SYSTEM MAINTENANCE FORM Date Pumped; / p f #of Tanks Pumped: Total Gallons Pumped: Sev t", Site Address: Owner's Name: C��.1.� �! �c �.�? _• /�- �i,/t , �1� Owner's Address (If different from site): Maintainer's Name: Lo, V0 dde S License Number: Private Residence: Commercial: Disposal Location: eyy%it tt� W W T Condition of Baffles: 471 Type of Tanks:l JCS' eA A I Slze of Tanks: Pumped Through: Effluent Sewage Discharge: Yes: No: Comments: a ��" ,.�1 Q.2-- �- �,.0 JJL Cj l -ct•.�c- _.... Please submit completed fortes to the Building Inspections Division via mall,fax or email. Ju1. 06.2017 04:47 PM Valley Blacktopping, Inc. 6514523220 PAGE. 3/ 6 LIKE us on Facebook; Terms Due Date P.O, No. "wV1SA&Mastercard Accepted LaRoche`s Sewer,Drain A processing fce of 2%«•i11 be addcd &Septic Services Nct 15 6/2/2017 to the transaction. Serviced Description Amount 5/9/2017 Pumping of the shop septic tank and the two tanks at the Mini-Storage 385.00 Building-fee includes disposQ1 at the Empire Waste Treatment Plant: Balance Due $385.00 Thank You — Your Business is Valued and Appreciated! Like us on Facebook Late Fees will be added to all past due accounts. I-aRoche's sewer,Drain&Septic Servicas Visa&Mastercard acceepted.