4064 Blackhawk Rd - COC41 City of Ea all
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: 1 30 4 la_c neL L s( _LO
COMPLIANCE WIT H INITIAL INSPECTION
f f Ihis is to certify that the property listed above has been inspected by authorized City personnel on - 3 - , 201
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 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 - required corrective repair work under (check all that apply):
n City Sanitary Sewer Permit n 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 tot
Grease Build -up, Root Intrusion, Dip /Settlement in Pipe, Other:
City Approved: � v � I l� � _ / a- - C1 !
Print name Signature Date
White Copy: Property Owner Yellow Copy: City of Eagan (Parcel File)
City of Ea all
rev. 2 23.