3336 Septic Memorial Hwy - Septic Maintenance From 2024-11-073830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplans(cDcityofeagan.com
Date Pumped:
Site Address:
Owner's Name:
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For Office Use
I I
Date Received:
I I
I Staff: I
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SEPTIC SYSTEM MAINTENANCE FORM
� � # of Tanks Pumped: PumpGallons y —
Owner's Address (if different from site):
Owner's Email: Owner's Phone #: tOFJ •'pL. J d -11."
Maintainer's Name: C,{� ��... License Numb
Private Residence: Commercial: Disposal Location: I
Condition of Baffles: ( o b& Type of Tanks: v Size of Tanks: v
Pumped Through: , Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form: Date: 11 I Zq&4
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Please submit completed forms to the Building Inspections Division via mail, fax or email.