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885 Lakewood Hills Rd - Septic Maintenance Form 09/27/20233830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 1 FAX: (651) 675-5694 Plan Submittal: ealansecitvofeaoan.com --------------------- For Office Use I I I I I Date Received: I I I Staff: I II --------------------- SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 4 2rJ 2 # of Tanks Pumped: �, Total Gallons Pumped: Site Address: Z95 IAREW O oh H 6 LLs R , ffAsAN1 heV Q- �;'l--20 Owner's Name: �� �� G IToo Owner's Address (if different from site): EAGAN �1 Owner's Phone #: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 1 FAX: (651) 675-5694 Plan Submittal: ealansecitvofeaoan.com --------------------- For Office Use I I I I I Date Received: I I I Staff: I II --------------------- SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 4 2rJ 2 # of Tanks Pumped: �, Total Gallons Pumped: Site Address: Z95 IAREW O oh H 6 LLs R , ffAsAN1 heV Q- �;'l--20 Owner's Name: �� �� G IToo Owner's Address (if different from site): Owner's Email: Owner's Phone #: /� 65l ` 47 4 32� b L �'-�'y 5FAVtNumber: Maintainer's Name: License Private Residence: Commercial: Disposal Location: — Condition of Baffles: Type of Tanks:–� Size of Tankj; Through: t/AWW ROY, Sewage Discharge: Yes: No: Pumped Effluent Comments: Name of Person Completing Form: g tljii `, Date: 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. PO BOX 40 kleyer—o AFTON, MN 55001 Sewer 6 - Family Owned Business Since 1976 Service (651) 459-0162 www.MeyerSewer.com CHECK /^ ly+l� minnasoia CASH CHARGE CREDIT CARD CHARGES PLEASE CALL DATE/j 7 NAME ADDRESS PUMPED AND BACKFLUSHED: p is Ink ve o Tan Pump (Lift) Tank Cesspool Holding Tank Sump Cleaned Filter Used Crust Buster to break up thick crust Extra Backflushing � 0 %�D�l feet of hose (Extra charge for over 120 feet of hosel, County Fee or City Fee Disposal Fee OTHER REPAIRS: Weekend or Evening Charge TOTAL GALLONS: 15Q� TOTAL COMMENTS: 86 T Licensed • Bonded • Insured RECEIVED BY: Licensed by the --ii- -- agency �28� 7 a