3505 Trails End Rd - Septic Maintenance Form 2017-07-24 Jul 25 2017 04:OOPM LaRoche's Sewer & Septic 5073344692 page 1
�____________________I
I For Office Use t
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Date Recelved: FEGE ED I
Get of Eaza Il ff Sta :L____________________
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675.5675
Fax; (651) 675.5694
Email: commdeveloamentOcityofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: - a y— 1 #of Tanks Pumped: Total Gallons Pumped: (0 O
Site Address: �Jd�J �rCi `S CY1 d 190Q8
Owners Name: —C,
Owner's Address(if different from site):
Maintainer's Name: `-���C- S Y,jyG�h 1, �G License Number:^--C�d
Private Residence: Commercial: Disposal Location: En-r 1%TV_ WQ
Condition of Baffles: U. -N6oux- r%o-i-SWj.- Type of Tanks: (�'�� Size of Tanks:
Pumped Through: �„ O.C SS Effluent Sewage Discharge: Yes: No: _�t
Comments:
lS Sa + a��D 'MohtaX.�u.1
Please submit completed forms to the Building Inspections Division via mail,fax or email.