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CITY of ANDO,VER <br />1GB~5 OFiOSGTOWN BOULI=VAFIO N.W.'," ~NDOVE.R~ MINN~$OY~-~04 ° ($12) 755-5100 <br /> <br /> CERTIFICATION OF GP, ADING <br /> AND <br /> PLACEHENT OF'CORNER IRONS <br /> <br />DATE: <br /> <br /> THIS DOCUH£NT HLIST BE SUBMITr~.D TO THE.CITY BUILDING DEPARTHENT <br /> AND APPROVED BY TIlE CITY EhlGIIqE£R PRIOP~ TO ISSUANCE OF A CERTIFICATE <br /> ',OF OCCUPANCY: :' <br /> <br /> Lot Block '. <br /> Subdivifion Name " <br /> <br />Addres~ <br /> <br />I hereby certify, that on the ~ day of . , 199. ; I conducted an on-site inspection at the <br />above reference location. I further ver!fy~ th"a~ the as~built grades and elevations of the site and building are in <br />accordance with the Developm~nt./Grading Plan or amendments appro. Ved by the City/ha/neet. in addition, <br />all corner irons are in place as of thLs da~e. ' ' <br /> <br /> Signed: <br /> Printed/Typed Name (Aegi~.er~ Land Surveyors): <br /> HinnesOta Re~ratlon No. .. <br /> <br />Note: Attach a copy of the Ce~'ficate of Survey <br /> sl~owing ~!1 approved elevations and as-builts. <br /> <br />ANDOVER ENGINEERING DEPARTMENT <br /> <br />Approved Denied Signed <br /> <br />Dated · " <br /> <br />Remar/~ <br /> <br /> <br />