1850 Gold Tr - COC411 City of EaaaIl
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eapil
City of Eagan, Minnesota
Property Address: I S ( C;
COMPLIANCE WI [H INIIIAL INSPECTION
This is to certify that the property listed above has been inspected by authorized City personnel on ` , 201_
and found to be in compliance with Section 3 40 of the City Code and no corr ective work was required
COMPLIANCE AF TER CORRECTIVE WORK PERFORMED
U 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 wor under (check all that apply):
City Sanitary Sewer Permit n City Plumbing Permit
NOTE.. Applicable only if box is checked.:[ used on a review of the Sewer Service 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: � W". 4 O,��
Print name
White Copy: Property Owner
Signature Date
Yellow Copy: City of Eagan (Parcel File)
rev 2 23 2010