HomeMy WebLinkAbout1328 Carlos Avenue - SL - 2022.10.25 - 10 Yearsi
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City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: 1-57-1 PiA(Li d S AVE, Tested Date:
Owner: VAO-JAA 9r TF Nity1O Building Permit#:
Contractor Name: j�tA�Lg(ry( PL Vrt't�r�f. LLL Encroachment Permit#: PWS,T- Q U'k
City Staff Name: CA'Ttn>I r -3A
Cleanout Location:
❑ Front
® Rear
❑
Left
❑
Right
Face of Curb
Lateral Size:
Cleanout: ® Existing ❑ New Installation
Comments and/ or
Sketch: WMI'A", 115SK Yp6iA� LbS.c 19-46
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Test Type: IF' Water ❑ Air
Status: 1R. Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year I,$
Partial Repair Made 10 Year ❑
New Installation 25 Year 0