HomeMy WebLinkAbout4135 South Rpbert Tr - Septic Maintenance Form 2026-02-1914 4 / /
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EAGAN
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3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplans(a)_cityofeagan.com
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For Office Use
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Date Received:
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I Staff:
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SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: L, '�---Z.1-- 2- Pumped:
or
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Site Address: `� �—� W� , l
Owner's Name: t �- 1C L lU oo
Owner's Address (if different from site):
Owner's Email: Owner's Phone #:
1
Maintainer's Name:�t �L- is e V�t��j ���v'�� �tve S a/� i °L License Number:
Private Residence: Commercial: Disposal Location:� ��, �; �.ST� it %l'1� i �'t�1A64A
Condition of Baffles: Type of Tanks: l to S Size of Tanks: (r��
] ��10 J
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Pumped Through: �'` �� I Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form: Date:Zj�ut
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Please submit completed forms to the Building Inspections Division via mail, fax or email.