1350 Rocky Lane - Septic Maintneance Form 2024-08-14i 4
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E AG A N
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplans(Mcityfeagan.com
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For Office Use
I I
Date Received:
I
I Staff: !
II
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SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped:,'� ' 2 oLy _ # of Tanks Pumped: Total Pumped:
dm
Site Address:
1-1150 RbA ll LCA
Owner's Name: ���!'�`�'� La Go p,
I's SIQ3
Owner's Address (if different from site):
Owner's Email: �- c�1 at �S i@ a . C d"! Owner's Phone #: 6;1 - 3 3S - V D 0
hAoin+nina?c nlamo• NC -1 PLAM C;Ar1C71 License Number: o 1
Private Residence: X Commercial: Disposal Location: e p1 1p :ce,
IDDQ-
Condition of Baffles: C, C),)j Type of Tanks: Size of Tanks: Q-
Condition
Through: V4a1411� e -
Comments:
Effluent Sewage Discharge: Yes: No: X
Name of Person Completing Form: (�fe5,, 6c),fazp" Date: IV/ zo%ady
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.citvofeanan.com/subscribe.
Please submit completed forms to the Building Inspections Division via mail, fax or email.
B's Pumping Service
IWO PO Box 767 1 Lakeville, MN 55044
651-460-8015 1 maddie@bspumping.com I https://www.bspumping.com/
RECIPIENT:
Larson, Theresa
1350 Rocky Ln
Eagan, MN 55123
For Services Rendered
Septic Tank Pumping Measured solids and pumped tanks as required 1 $425.00 $425.00*
Coupon 1 -$35-00 -$35.00*
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