HomeMy WebLinkAbout1417 Cabrillo Avenue - SL - 2022.10.18 - 10 YearsP
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: MIM P.h'O\t-Avt,U i4yZ,- Tested Date: iL) (`'i'LZ
Owner: MP( -T -9 \J GG.IT(VLL V )* '" Ra F\' Building Permit #:
Contractor Name: (,\J�j S'S'4iT'\ C-112" PA.Y Encroachment Permit#: 1D\rJ%Z- t) SP( 1
City Staff Name: hpry\p ',�g4)y,>p
Cleanout Location: 1A Front
❑ Rear
❑
Left
❑
Right
Face of Curb
Lateral Size:
Cleanout: V Existing ❑ New Installation
Comments and/ or
Sketch: \nik�'6•,.1L -TSi iSY{� P0 WA�TfiN L4-1
Test Type: ® Water ❑ Air
Status: Nr Pass ❑ Fail
Sewer lateral Condition: Exemption Type:
No Repair Needed 10 Year
Partial Repair Made 10 Year ❑
New Installation 25 Year