Fillable Form 1: Address Owners Name Date No. 1685 (City of Andover)

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Form 1: Address Owners Name Date No. 1685 (City of Andover)

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1685 CROSSTOWN BOULEVARD NW, ANDOVER, MINNESOTA 55304 (763) 755-8700 • FAX (763) 755-8923 • WWW.ANDOVERMN.GOV
The fee for each pumping permit is $20.00.
PLEASE SUBMIT PUMPING REPORT TO CITY WITHIN 30 DAYS AFTER PUMPING
Plumbing /Septic/Utilities Contractor
License Number
E-Mail Address
Mail Address
Contact Person
Telephone
Mobile Telephone
No.
Address Owner’s Name
Date
Pumped
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Form 1: Address Owners Name Date No. 1685 (City of Andover)

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Completed 2 August 2020

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