1845 Gold Tr - COCCity of EaRall
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Proper ty Address: ' � 5 C3 \.(
COMPLIANCE WITH INITIAL INSPECTION
Ihis is to certify that the property listed above has been inspected by authorized City personnel on } , 2011
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 corrective repair work under (check all that apply):
City Sanitary Sewer Permit I City Plumbing Permit
NOTE: Applicable
recommended th
7 ease Build -up,
only if box is checked: I ased on a review of the Sewer Service video inspection /report on file, it is
ertorl c �f iii ing or future inspections be performed to minimize a potential blockage due to:
usi�re, 1i Settlement in Pipe, Other: 3 I
City Approved: t' vv ( ),
Print name
White Copy: Property Owner
Signature
Yellow Copy: City of Eagan (Parcel File)
Date
City of Eagan
rev 2,