4292 Beaver Dam Rd - COCCity of hap
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota (�
Property Address:` 9 CLCD
COMPLIANCE WITH INITIAL INSPECTION
-Ihis 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 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):
n City Sanitary Sewer Permit n City Plumbing Permit
NOTE: Applicable only if box is checked: UBased 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:
White Copy: Property Owner
Print name Signature
Yellow Copy: City of Eagan (Parcel F ile)
WaO
Date
City of Ea all
rev 2.23 2010