HomeMy WebLinkAbout1334 Benito Avenue - SL - 2022.11.03 - 25 YearsCity of Burlingame
Public Works Department
i'
�'��.•e, Sewer Lateral Test Certificate
Address: 1'"v �N Tested Date: 22
Owner: �.�(/j �— Building Permit#:
Contractor Name: �� rJNCQ� Encroachment Permit#:
City Staff Name:
Cleanout Location: ❑ Front 1 Rear ❑ Left Right
/Fa`ce of Curb
Late raI Sze: 4 TestType: Water ❑ Air
Cleanout: ❑ Existing New Installation Status: Pass ❑ Fail
Commentsend/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Fle air Needed 10 Year ❑
Partial Pe air Made 10 Year ❑
New Installation 25 Year