CITY OF CLARKSON VALLEY
PLUMBER VERIFICATION FORM

I, ___________________________________________________________, of ________ ___________________________________Plumbing Company have taken steps to cable and/or televise the sanitary sewer lateral at _____________________________________ on the ________ day of ___________________, 20____.

The work I have done has not been adequate to completely clear the line and I recommend that additional steps be taken to repair this sanitary sewer lateral.

I believe the problem area is approximately __________ feet from the house or ________ feet from the edge of the street.

		Signed _____________________________
		Company ___________________________
		Date _______________________________


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