1776 Walnut Lane - COCCity of hp
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
pity of Eatall
City of B,agan, i Minne } sota
Property Addt ess: \ti W&k
COMPLIANCE WITH JNIIIAL INSPEC TION
-'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 required,
COMPLIANCE AFTER CORREC I IVE WORK PERF ORMED
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):
I
City Sanitary Sewer Permit 1 City Plumbing Permit
NOTE: Applicable only if box is checked: 1 '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, Boot Intrusion, Dip /Settlement in Pipe, Others
City Approved:
Print name
White Copy: Property Owner
Signature
Yellow Copy: City of Eagan (Parcel File)
Date
rev. 2 23 2010