HomeMy WebLinkAbout920 Azalea Avenue - SL - 2022.09.16 (25)Address: 1 tiC>./ %6t 4,(_{J L. ".t
Owner: S�t., 4 I1"4y` " All,"
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: ON / /, / -. Z --
Building
Building Permit #: I'L "L - b ( 3 7
Contractor Name: -\(,.,5 J w. 6 Ir...c Encroachment Permit #:
City Staff Name:
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: t{ L /
Cleanout: ❑ Existing 0 New Installation
Comments and/ or
Sketch:
Test Type: -fes Water ❑ Air
Status: -Iff- Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year ❑
Partial Repair Made
10 Year ❑
New Installation
25 Year