4858 Richard Lane - COCCity of Ea all
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eapll
City of Eag an, Minnesota
Property Address: Lc, v,.
COMPLIAN CE WHIT INITIAL INSPEC TION
Ihis is to certify that the property listed above has been inspected by authorized City personnel on f , 201
and found to be in compliance with Section 3 40 of the City Code and no corrective work was required.
COMPLIANCE AF TER CORREC JIVE WORK PERFORMED
Ihis 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: 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: U\r■
Print name Signature Date
White Copy: Property Owner
Yellow Copy: City of Eagan (Parcel File)
rev 22.32010