1412 Rebecca Lane - COC4 City of hp
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: H
COMPLIANCE WITH INITIAL INSPECTION
FA —This is to certify that the property listed above has been inspected by authorized City personnel on 0 , 201_0
and found to be in compliance with Section 3 40 of the City Code and no corrective work was required.
COMPLIANCE AF TER CORRECIIVE WORK PERFORMED
fl 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
NOTE:' Applicable only if box is checked: 1 (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: ` k
Print name
White Copy: Property Owner
n City Plumbing Permit
Y--
U
Signature
Yellow Copy: City of Eagan (Parcel File)
l l ! D-4 (g
Date
City of Ea all
rev 2 23.2010