Loading...
2750 Lexington Ave - Septic Maintenance 07/11/24EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 1 FAX:(651) 675-5694 Plan Submittal: eolans(@citvofeagan.com --------------------- For Office Use I I Date Received: I I I Staff: I ---------------------I SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: 1 - 11 _ l y # of Tanks Pumped Site Address: 11 Total Gallons Pumped: 1000 Owner's Name: C-Vossl_oyntrY FreiQi1t Sb`Vt10ytg Owner's Address (if different from site): Owner's Email: + Owner's Phone #: Maintainer's Name: I" \ eI e y J 2,nJ [- EY`11 c-e, License Number: Private Residence: (Commercial: ✓ Disposal Location: Sk F k,) 1 umV. p- M 0- n'i P l an Condition of Baffles: V D ecl Type of Tanks: 5 pp}" C� Size of Tanks: 1000 Pumped Through: Man\no\P Effluent Sewage Discharge: Yes: No: Comments: Name of Person Completing Form: CYtr-,9 v l 1Anl3r Date: -I - l\ - it 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.citvofeaoan.com/subscribe. Please submit completed forms to the Building Inspections Division via mail, fax or email.