3917 Blackhawk Rd - COCCity of hp
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
411 City of Evan
City of Eagan, Minnesota
Property Address: �� 1 1JCi C�Ct ln� P
COMPLIANCE WITH INITIAL INSPECTION
This is to certify that the property listed above has been inspected by authorized City personnel on - , 201_I
and found to be in compliance with Section 3 . 40 of the City Code and no corrective work was required
COMPLIANCE AF TER CORRECTIVE WORK PERFORMED
1
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):
Print name
White Copy: Property Owner
City Sanitary Sewer Permit ! I City Plumbing Permit
NOTE: Applicable only if box is checked: f" -lased on a review of the Sewer Service video inspection /report on file, it is
recommended that per iodic cleaning or future inspections beperformed to minimize a potential blockage due to:
Grease Build -up, Root Intrusion, Dip /Settlement in Pipe, Other: D-3 _5
D `
City Approved: t vv � �
Signature Date
Yellow Copy: City of Eagan (Parcel F ile)
rev. 2 23 2010