1775 Walnut Lane - COC411 City of Evan
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Pt apex ty Address: � n \ lf \
COMPLIANCE WITIIINIIIAL 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 corrective work was required.
COMPLIANCE AFTER CORRECIIVE 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):
n City Sanitary Sewer 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:
Print name
White Copy: Property Owner
n City Plumbing Permit
Signature Date
Yellow Copy: City of Eagan (Parcel File)
City of Evan
rev 2 2.3 2010