HomeMy WebLinkAbout965 Chula Vista Avenue - SL - 2022.11.18 - 25 Yearsa
Address:
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: 4 s2��
Owner:
�( Building Permit#: i 1'�� V I
Contractor Name: ►' !`� Encroachment Permit#:
City Staff Name:
Cleanout Location: ❑ Front X Rear ❑ Lek ❑ Right
I)
Lateral Sze: 1 Test Type: Iter ❑ Air
Cleanout: ❑ Existing New Installation Status: Pass ❑ Fail
Comments and/ or
Sketch:
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year ❑
Partials air Made
10 Year ❑
New Installation
25 Year