4200 Sibley Memorial Hwy - COCCity of Ea all
Property Addh ess:
COMPLIANCE WIIH INITIAL INSPECTION
Ihis is to certify that the property listed above has been inspected by authorized City personnel on S
and found to be in compliance with Section 3 40 of the City Code and no corrective work was required
COMPLIANCE AFTER CORRECTIVE WORK PERFORMED
n Ihis 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):
n City Sanitary Sewer Permit 1 1 City Plumbing Permit
NOTE: Applicable only if box is checked; Based on a review of the Sewer Set vice video inspection /report on file, it is
recommended that periodic cleaning or future inspections be performed to minimize a potential blockage due to:
Grease Build-up, Root. Intrusion, Dip /Settlement in Pipe, Other:
City Approved:7Y WL l, 1� f VV 4 \ l l� 1 ' 10 / wa
Signature Date
Print name
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
co os M -evy(
Yellow Copy: City of Eagan (Parcel File)
4111 City of Evan
,201
rev 2 23 2010