HomeMy WebLinkAbout261 Park Road - SL - 2022.11.10 - 10 Yearsa.
City of Burlingame
-BURIJNGAMIE Public Works Department
Sewer Lateral Test Certificate
Address: _ �� p✓ Qy/tl'� Tested Date: i t 1 )v r 22
Owner: ¢/tlfj?7N Gd ' iy p/t�fl-iy t, Building Permit #:
Contractor Name: L1r-sS)5—,4VYl C L YVPA-0)! Encroachment Permit #: D`�'iJb' OLS
City Staff Name: IWINS UTayt�LF
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: x Test Type: V1 Water ❑ Air
Cleanout: ® Existing ❑ New Installation Status: Q Pass ❑ Fail
Comments and/ or
Sketch: WKTF-A- fiC-,4 N7A6'AA) W WAI'a., W5T
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
Partial Repair Made
10 Year ❑
New Installation
25 Year ❑