HomeMy WebLinkAbout1037 Cortez Avenue - SL - 2021.10.26 - 25 YearsCity of Burlingame
BU RLINGAM[
Public Works Department
5Y16.q
Sewer Lateral Test Certificate
Address: Tested Date:
Owner. Building Permit #:
Contractor Name: Encroachment Permit #:
City Staff Name:
Cleanout Location: ❑Front � Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: Test Type: 11 Water ❑ Air
Cleanout: ❑ Existing New Installation Status: /Pass ❑ Fall
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year
ET,/