4346 Nicols Rd - COCCity of Eapli
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of btu
City of Eagan, Minnesota ( '' n
Property Address: 3 Lt \ l co ‘S I_LJ C 9
COMPLIANCE WIIH INITIAL INSPECTION
Ihis is to certify that the property listed above has been inspected by authorized City personnel on , 201(3
and found to be in compliance with Section 3.40 of the City Code and no corrective work was required
COMPLIANCE AF TER 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):
n City Sanitary Sewer Permit n City Plumbing Permit
NOTE: Applicable only if box is checked: eased on a review of the Sewer Service video inspection /report on file, it is
recommended that perio ning or future inspections be performed to minimize a potential blockage due to:
Grease Build -up ' oot Intrusion, Dip /Settlement in Pipe, Other: 33- , 4 S5 , 3_ S (e,
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City Approved: /
t ifvt ��� 1/�-v - l
Print name l Signature r Date
Yellow Copy: City of Eagan (Parcel File)
rev 2.23 2010