2123 Shale Lane - COCCity of Ca all
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: -e 'LOLA\
City of Ea pi
COMPLIANCE WIIII INIIIAL INSPECTION
T his is to certify that the property listed above has been inspected by authorized City personnel on , 201
and found to be in compliance with Section 3 40 of the City Code and no corrective work was required.
COMPLIANCE AFIER CORRECTIVE WORK PERFORMED
U 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 r epair work under (check all that apply):
n City Sanitary Sewer Permit n City Plumbing Per
NOTE: Applicable only if box is checked.: nBased 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: / i 1rv— \ - Z . F0
Print name Signature Date
White Copy: Property Owner
Yellow Copy: City of Eagan (Parcel File)
rev. 2 23 2010