HomeMy WebLinkAbout761 Farringdon Lane - SL - 2022.10.04 (10)City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: -] (A C MIA( ) r G'N,5 -S L-0 . Tested Date: \D i !, I 11
Owner: VF,U k(0 301-Y T"L, Building Permit#:
Contractor Name: y5GO">< Ylu \v'L Encroachment Permit#: t>WyE,-US(,Q
City Staff Name: l�pry\7 C.Ad�\'7b�A
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
Face of Corb
„
it
Lateral Size:
Cleanout: 0 Existing ❑ New Installation
Comments and/ or
Sketch:
Test Type: R Water ❑ Air
Status: F}' Pass ❑ Fall
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
J
Partial Repair Made
10 Year
New Installation
25 Year
❑