4628 Kingsbury Dr - COCCity of h
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City Approved: t vv,
Print name
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: } 'i b u. Y •D
FT INITIAL INSPECTION
E4 is to certify that the property listed above has been inspected by authorized City personnel on t -1 " 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
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
1
NOTE: Applicable only if is checked: j Based on a review of the Server Service video inspection /report on file, it is
recommended that periodic cleaning or future inspections be per forrned to minimize a potential blockage due to:
Grease Buildup, Root Intrusion, Dip /Settlement in Pipe, Other:
Signature Date
aRaft
Yellow Copy: City of Eagan (Parcel File) rev. 2.23.2010