HomeMy WebLinkAbout917 Azalea Avenue - SL - 2022.11.21 - 25 YearsBUR AME City of Burlingame
Public Works Department
`'•�• ••'" Sewer Lateral Test Certificate
Address: / p Tested Date: 2 r—
Owner: Building Permit#: %'�-(ice
Contra cto r Na m e: AT K/fiV - Encroachment Permit#:
City Staff Name: / a
Cleanout Location:
Lateral Sze:
Cleanout: ❑ Existing
Comments and/ or
Scetch:
Front
❑ Rear
❑ Left
❑ Right
Air
New Installation Status: V Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Pa air Needed 10 Year ❑
Partial Pe air Made 10 Year ❑
New Installation 25 Year