4100 Blackhawk Rd - COC4 City of Eaftall
City of Eagan, Minnesota
Property Address: L A \ Bk.QC may` C J
COMPLIANCE WIIH INITIAL INSPECTION
This is to certify that the property listed above has been inspected by authorized City personnel one , 2011
and found to be in compliance with Section 3.40 of the City Code and no corr ective work was required
COMPLIANCE AFTER CORRECTIVE WORK PERFORMED
This is to certify that the property listed above has been found to be in compliance with Section 3 40 of the City Code
after satisfactorily completing the required corrective repair work under (check all that apply):
NOTE.: Applicable only if box is checked: LjBased on a review of the Sewer Service video inspection /report on file, it is
recommended that periodic cleaning or future inspections be perfor a to,mrni ize a potential blockage due to.'
Grease Buildup, Root Intr. usion, Dip /Settlement in Pipe, Other:
City Approved:
City Sanitary Sewer Permit [7 City Plumbing Permit
Print name
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
Signature Date
41 City of Eagan
Yellow Copy: City of Eagan (Parcel File) rev 2 23 2010