3864 Palisade Way - COC41 10 / City of Evan
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
351a4 PoiA
COMPLIANCE WITH INIIIAL INSPECTION
Property Address:
'F is to certify that the property Listed above has been inspected by authorized City personnel on -5. a , 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
n 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 fl 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
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: .. _ i 'v.
Print name
White Copy: Property Owner Yellow Copy: City of Eagan (Parcel File)
k I / a t(
Signature - Date
City of Eapll
rev. 2 23.2010