560 Lone Oak Rd - Septic Maintenance 7/11/241
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplans cityofeagan.com
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I For Office Use
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Date Received:
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Staff:
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Total Gallons
Date Pumped: # of Tanks Pumped: Pumped:
Site Address: l_.��: � � C 4, C
Owner's Name: ,( �� ( Ky� 11\ t
Owner's Address (if different from site):
Owner's Email: Owner's Phone #:
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Maintainer's Name: License Number:S ��
Private Residence: Commercial: Disposal Location:
Condition of Baffles: Type of Tank�L� Size of Tanks:
Pumped Through: \ Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form:
Date: ` y
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Please submit completed forms to the Building Inspections Division via mail, fax or email.