HomeMy WebLinkAbout5 El Quanito Way - SL - 2022.10.11 - 10 Yearsa IY'
" BURL7NGAME
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: S $L Q'A t,1%TU sr." Tested Date: w II 1 'lZ
Owner: LAW 1>M%9 USIA 1 P>P/.^TY Building Permit #:
Contractor Name: ATL/t�, PuAyt#j)J L �'fJD ,h' Encroachment Permit #: QyJ 2'1.
City Staff Name: 15/417 eA4V O,:q
Cleanout Location:
❑ Front
M Rear
❑
Left
❑
Right
10Year .fa
Face of Curb
New Installation
25 Year ❑
R
Lateral Size:
Cleanout: Q Existing ❑ New Installation
Comments and/ or
Sketch: hM7 W/k'rQ- LV i .
Test Type: 19 Water ❑ Air
Status: ® Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
Partial Repair Made
10Year .fa
New Installation
25 Year ❑