3350 Hwy 55 - Septic Maintenance 10/23/2024EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-56751 FAX: (651) 675-5694
Plan Submittal: eplans(Mcitvofeaoan.com
Date Pumped:
Site Address:
Owner's Name:
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For Office Use
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Date Received: I
I
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I Staff: I
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SEPTIC SYSTEM MAINTENANCE FORM
# of Tanks Pumped:
Total Gallons r�
Pumped: J
3 35D 14..r� 55 F aaa r` Mt-1 55121
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Owners Address (if different from site): 3.3 �'� /y"Lll yi7 . �Q. %7 . / �� • ' fSJria[i ���) y
Owner's Email: m7C !;d 1 j',Q1aQo(9 marl/C 17-) Owner's Phone#.
Maintainer's Name: Awe" 5t,.& �License Number:
Private Residence: )JCommercial: Disposal Location: -.4y
Condition of Baffles: //`l lea &14 Type of Tanks: Size of Tanks: i2e,
Pumped Through: t, Effluent Sewage Discharge: Yes: No:
or
Comments:
Name of Person Completing Form: as 411,.._ Date: /B d3 -a Y
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Please submit completed forms to the Building Inspections Division via mail, fax or email.