4437 Clover Lane - COC4,01/1`
City of Evan
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Propel -IT Address: 44'37 C (d v t r Lk-)
4,11 City of Evan
COMPLIANCE WIIII INITIAL INSPECTION
This is to certify that the property listed above has been inspected by authorized City personnel on Q 25— , 2011
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
I�
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 City Plumbing Permit
NOTE:Applicable only if box is checked.: u$ased on a review of the Server Service video inspection/report on file, it is
recommended that periodic cleaning or future inspections be performed to minimize apotential blockage due to:
Grease Build-up, Root Intrusion, Dip/Settlement in Pipe, Other
City Approved: JAS
Print name
White Copy: Property Owner Yellow Copy: City of Eagan (Parcel F ile)
rev 2.23 2090
City of EaQali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694.
JUL i h 2O1
r
Permit #:
Permit Fee:
Date Received:
Staff:
1
L
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: -7/0119" Site Address:
Tenant:
Susan Olson
4437 Clover Lane
Suite #:
RESIDENT / OWNER
Lagan, MN 55122
Name: 6514560709 a:
Address / City / Zip:
CONTRACTOR
� �v(P,,
Name: NORBLOM PLUMBING CO. License #: W t 52-4 ir
0(0152-4
Address: (612) 827-4033
City: 2905 GARFIELD AVE. SO. State: zip:
MINNEAPOLIS, MN 55408
Phone: Contact Person: Arritj
TYPE OF WORK
New X Replacement Repair Rebuild Modify Space Work in R.O.W.
_ _ _
Description of work: repktc6 Water G 1ea
PERMIT TYPE
RESIDENTIAL
1 Water Heater Water Softener
Lawn Irrigation Add Plumbing Fixtures
( RPZ / _ PVB) ( Main Lower Level)
Septic System Water Turnaround
New
_
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation
$50.50 Add Plumbing
*Water Turnaround
$100.50 Septic System
$90.50 Fire Repair (replace
I h b k I d
(includes $.50 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge)
(add $165.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $ L5•-----
ere y ac now a ge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
x Je-ffreA4 iVorbiarn,
Applicant's PrintelfName
A.,%' icant's Signature