4650 Ridge Cliffe Dr - COCCity of Eapll
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City or
City of Fagan, Minnesota
Property Address: 4 (E,51) ek � C 4 S"c---e_ Gy-', L/'' -e_-
COMPLIANCE WITH INITIAL INSPECTION
rs to certify that the property listed above has been inspected by authorized City personnel on 4 — , 201_0
found to be in compliance with Section 3.40 of the City Code and no corzective work was required.
COMPLIANCE AF IER CORREC LIVE 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 r
City Approved: J ON. 4 l>` — � / 1 / V 1-D-0 ! U
Print name Signature Date
White Copy: Property Owner
Yellow Copy: City of Eagan (Parcel File) rev 2 23 2010
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: ///2
Permit Fee: /OS
Date Received: '' 4,7
Staff:
I nn2012 RESIDENTIAL BUILDING PERMIT APPLICATION
/
Date: JOt�G I v I Site Address: 1 CrO Unit #:
Kki+i' nA.c.44 f2-
Phone: 1Z, VW, 84144
6 e, A' A.12-16
Applicant is: Owner Contractor
Description of work: ttG, I ,1 % .S
Construction Cost:
Company:CAA-M 7(Qfel VV tN(SOW W. Contact: 'PON I 4Mc' lOi
Address:' (t 4c 9( tl�
. (o ✓• r . 1 `
City: €»i 6
1
State: MM Zip: 91fPhone: (.0 - 614 - 105+
License #: 86 MI (i01. Lead Certificate #: -rzoet4P5-o
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
)TE rPlans:and suppor On documents, hat yo t s
# rnlo mation mayTbe classifiedras non-public if
co 1:0 0:111f. t
mit are considered to'be public informal
01,1 provide specific reasons that would pe
,e are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge 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 1 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota
days of permit issuance.
x [Gonl -AN't7Eg'7b&)
Applicant's Printed Name
x d
App
to Building Code must be completed within 180
4
cant's Signature
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