3917 Beryl Rd - COC4 4 1111 C ity of
1
City Approved: J\ \ V1r` u``�
Print name
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Pr apexty Address: 4
COMPLIANCE WITII INITIAL INSPECTION
his 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 corrective work was requited
COMPLIANCE AF TER CORREC IIVE WORK PERFORMED
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 r equired corrective repair work under (check all that apply):
City Sanitary Sewer Permit City Plumbing Permit
NOTE: Applicable only if box is checked: I used on a review of the Sewer Service video inspection /report on file, it is
recommended that per cleaning or future inspections be performed to minimize a potential blockage due to
Grease Build -up, Root Intrusion, Dip /Settlement in Pipe, Other:
Signature Date
Yellow Copy: City of pagan (Parcel File)
4 City of Eagan
rev, 2 23 2010