HomeMy WebLinkAbout409 Burlingame Avenue - SL - 2022.10.14 (25)r
Address: �Anq tiN , ,C- \Q�Du �%.
Owner: 0�* Qf',AAe-,v-N
Contractor Name:
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City Staff Name: 1C,�lL
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: iv 14
Building Permit #: `\n
Encroachment Permit #:
Cleanout Location: ❑ Front .Er Rear ❑ Left ❑ Right
Face of Curb
Lateral Size:
Cleanout: ❑ Existing .I' New Installation
Comments and/ or
Sketch:
Test Type: Water ❑ Air
Status: -B� Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year ❑
Partial Repair Made
10 Year ❑
New Installation
25 Year .8--�