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3305 Lexington Ave - Septic Maintenance Form 2023-10-16,R4l1 rjEAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 FAX: (651) 675-5694 Plan Submittal: epians citvofeaoan corn --------------------- For office Use I ( I Date Received: I i I I ! Staff: I I---------------------I SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: _ - Z # of Tanks Pumped:I — pumped lions t Site Address: �—rit lCi f1°j �l out, 7 Owner's Name: � 1 Lc)54-tj Jo Owner's Address (if different from site): Owner's Email: Owner's Phone #: Maintainer's Name: IAP - ye r 5 t* t r t.r v i c e License Number: 0115 Private Residence: Commercial: Disposal Location: Trt �+ .r, e n r V 1, .t n fi .- Condition Condition of Baffles: t wt.A. Type of Tanks: G Size of Tanks: 60c..ri.-,/ Pumped Through: 54Z&4,1 !X ?l0 f Effluent Sewage Discharge: Yes: No: Comments: Name of Person Completing Form: � Date: to -� — 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 mn w.citvofeaaan.com/subscribe. Please submit completed forms to the Building inspections Division via mail, fax or email.