3344 Sibley Memorial Hwy - Septic Maintenance form 2020-10-06v
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplansCoDcitycfeagan.ccm
---------------------
For Office Use ,
I I
I I Date Received: II
I I
jStaff: I
L-------------------�
SEPTIC SYSTEM MAINTENANCE FORM
Total Gallons
Date Pumped: 2'l�1.2 ex: Ib ,,/#�of Tanks Pumped: MPumped: ( t
Site Address: .J311 -I S )jJle`I P tQMoIll 4Wl I fi�mAo ,
Owner's Name: C' ,Q�jl UgheS- j r Owner's Address (if different from site): SAr�e ChGt� ��> afCl6ye"
Owner's Email: i ���� QM'a� • �d M Owner's Phone #: 612 ' 6'14
Maintainer's Name: /ll r,.7Crl License Number:
Private Residence: )/�Commercial: Disposal Location:
Condition of Baffles: a;cd ell Type of Tanks: Ole-e-4.dSize of Tanks:
Pumped Through: /rt,�„ (,e��_� Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form: Y, I S W agre, ( Date: 1 0- (a 10
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 www.cityofeagan.comisubscribe.
Please submit completed forms to the Building Inspections Division via mail, fax or email.
5325 MANNING AVF SU , AtTON. Mrd SSrAt
Farally Owned Business Since 1976
S3
b www,MeyerSewer,com
Ill �
art;e ntiif rr, nri r .fRr- nnn
not arr;,
SERVICED
Cesspool
Holding Tank
.SkeIT�? tltet
Used Crust Buster to break up thick Crust
Extra Backffushing
ir; 0feet of hose (Extra charge for over 100 feet of hose)
Washington County Fee or City Fee
Sump or Ejector Pit
Flammable Waste Trip
Disposal Fee
Other
Repairs
Weekend or Evening Charge
TOTAL GALLONS
Commanbs�.
RECEIVED ey;
TOTAL
ucen+wn-8a,weanwur.e
W d frf �f•9
M�rx.wNo 4MMupai Lo+UvlApa�N.ti