3876 Palisade Way - COC4 City of Evan
11
City Approved:
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: 3
COMPLIANCE WIT II INIIIAL INSPECIION
7 his is to certify that the property listed above has been inspected by authorized City personnel on - ate , 201_
and found to be in compliance with Section 3 40 of the City Code and no corr ective work was r equired
COMPLIANCE AFTER CORRECIIVE WORK PERFORMED
7 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 n City Plumbing Permit
NOTE: Applicable only if box is checked:P1Based on a review of the Sewer Service video inspection /report on file, it is
recommended that periodic cleaning or future inspections be performed o minimize prt• tial blocka du e for
Grease Build -up, Root Intrusion, Dip /Settlement in Pipe, Other: — i rtf
1 c L
Print name
Signature
Yellow Copy: City of Eagan (Parcel File)
Ze0
City of Evan
rev 2 .23 2010