HomeMy WebLinkAbout430 Bloomfield Road - SL - 2022.09.20 (10)Address: 1 30 LUUT`t PI (,A a> 9,D .
Owner: S}tt I -Lay Y1
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: Cl I %ti ) Z2-
Building
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Building Permit #:
Contractor Name: nl SGUU JT PI,tAt^ !62 I J L I P(. • Encroachment Permit #: QW Z4. —V S2Q
City Staff Name: r)/<v I o p-Jt.(y,'� or1Ft
Cleanout Location: 19 Front ❑ Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: L,
Cleanout: ® Existing ❑ New Installation
Comments and/ or
Sketch: _ 'fr; SS 9X/V Q.' 2 - tyb VWrLL
Test Type: [9 Water ❑ Air
Status: ')a Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
Partial Repair Made
10 Year ❑
New Installation
25 Year 0