4106 Nicols Rd - COCCity of Eagan
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: 4 (# I c C k [�
COMPLIANCE WITH INITIAL INSPECTION
n 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 AF TER :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 1 City Plumbing Permit
White Copy: Property Owner
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 Budd -up, Root Intrusion, Dip /Settlement in Pipe, Other:
City Approved: f t [' f' t"S,�l/t 1 / (r(fq(11
Print name Signature Date
City of Eapll
Yellow Copy: City of Eagan (Parcel F ile) . rev 223.2010