1025 Wescott Rd - Septic Maintenance Form 2016-10-11 2010-07-04 02:54 » 6516755694 P 2f3
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For Office I
t I
1 Data Received;
City of Eapn i---------------------1
3630 Pilot Knob Road
Eagan MN $6122
Phone: (651)675.6675
Fax:(851) 975.5e94
Email: commdeyelop It an..
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: I V I I 16 #of Tanks Pumped: L Total Gallons Pumped; 9�
Site Address:
owner's Name:
Owner's Address(if different from site):
Maintainer's Name: �,,Juv j j���� �U i 6 Llcense Number; L z�G
Private Residence: Commercial: Disposal Location: 'L
Condition of Baffles pv J) Type of Tanks: ef'- ) Li d Size of Tanks; 2*0
Pumped Through: /,q I,>yele Effluent Sewage Discharge: Yes; No:
Comments:
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Please submit completed forms to the Building Inspections Division vie mall,fax or smell.