4868 Richard Lane - COCCity of Egli
1
City Approved:
Print name
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Min rota
7 Cji
Property Address: ! 0 �r O
P Y
COMPLIANCE WITH INITIAL INSPECTION !--
this 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 conective work was r equired
COMPLIANCE AF TER CORREC IIVE WORK PERF ORMED
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):
City Sanitary Sewer Permit 1 1 City Plumbing Permit
4 1 ! 1/1 City of Evan
NOTE:' Applicable only if box is checked, (Bused 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;
Signature Date
l 1 b
Yellow Copy: City of Eagan (Parcel File) rev 2 23 2010