HomeMy WebLinkAbout40 Bloomfield Road - SL - 2022.11.16 - 25 YearsAddress: IV K? MW
Owner: y✓
Contractor Na me: ririP ��JLtb, pi,
City Staff Name: *�
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date:
Building Permit#:
Encroachment Permit#:
0122—Otto 33
Cleanout Location: Front ❑ Rear ZEN Left ❑ Right
` Face of Curb
Lateral Sze: Testi e:® Water ❑ Air
Cleanout: ❑ Existing New installation Status: Pass ❑ Fail
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Paair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year