4877 Richard Lane - COCCity of by
White Copy: Property Owner
Print name
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: 5- 1
Signature Date
Yellow Copy: City of Eagan (Parcel File)
a. 1r1
City of Eaaall
COMPLIANCE WITH INITIAL INSPECIION
I ris is to certify that the property listed above has been inspected by authorized City personnel on l ` , 20I O
and found to be in compliance with Section 3 .40 of the City Code and no corrective work was required.
COMPLIANCE AF TER CORREC IIVE WORK PERFORMED
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 A 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: J (.l 1 \ t / Do lb
rev 2 23 , 2010