HomeMy WebLinkAbout520 lone oak rd - Septic Maintenance Form - 2024-10-23EAGAN
3630 PILOT KNOB ROAD I PAGAN, MN 55122-1810
(651) 675-5675 � FAX: (651) 675-5694
Plan Submittal: eolansCalcitvofeaaan.com
---------------------
For Office U.
Date Received: I
I
-- --I
SEPTIC SYSTEM MAINTENANCE FORM
'Y Total Gallons
Date Pumped: 10_2 v7 _a tl # of Tanks Pumped: p. Pumped: 00
Site Address: -5 Z 0 Lone 0,7 k )U i n InN SS / Z I
Owners Name: L720r�i2 Mlku LoWs,�l
J
Owners Address (if different from site):
Owners Email: 9kr Za M ha 1);59V cr nj,)I1. 6eAl Owner's Phone#: 6S1- Z 73
Maintainers Name: N41" �G[A/e ✓ License Number �7�J
Private Residence: /' Commercial: Disposal Location:
Condition of Baffles: 19 and Type of Tanks: _ Size of Tanks: ASMOV
./pG¢
Pumped Through: S Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form: i+ (C- *x 11 Date:
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.cltvofeaaan.comisubscribe.
Please submit completed forms to the Building Inspections Division via mail, fax or email.
Scn� 4- 1-1- LS