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945 Butwin Rd - Septic Maintenance Form 2023-05-24 RECEIVE JUN 0 5 2023 BY, ------------ -- - For Office Use --- - - EAGAN I Date Received: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 1 staff: (651 675-56751 TDD: (651)454-85351 FAX: (651)675-5694 buij 'P, SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: s Z4-7-.3 #of Tanks Pumped. 5 Total Gallons Pumped, 0 Site Address: C1 Ll �S -D V-V\A� ""-) IC, Owner's Name: J,, Owner's Address if different from site): Owner's Email: Owner's Phone#: Maintainer's Name: ,j 2 License Number: Private Residence: Commercial: Disposal Location: \Q Condition of Baffles: TYPe of Tanks; Size ofTanks: -S-fe— 7WO&At Pumped Through: # o Effluent Sewage Discharge; Yes: No: X Comments: You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at yy RQ-r—n/!jqbsqrLj Please submit Completed forms to the Building inspections Division Via mail, fax or email.