1714 Kyllo Lane - COC4 , 111 '' City of Ea BIl
Print name
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
1
Property Address: , t Fri{ L L-
COMPLIANCE WITH INITIAL INSPECTION
his is to certify that the property listed above has been inspected by authorized City personnel on , 201t
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
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 corr ective repair work under (check all that apply):
1 City Sanitary Sewer Permit n City Plumbing Permit
NOTE: Applicable only if box is checked: !Based on a review of the Sewer Service video inspection /report on file, it is
r ecommended 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:
r J
City Approved: \ vvw \ . 1�. -. / A LL � �� -�� / I ! 6
Signature Date
Yellow Copy: City of Eagan (Parcel File)
City of Evan
rev 2.23 2010