HomeMy WebLinkAbout935 Capuchino Avenue - SL - 2022.12.01 - 10 YearsAddress: "�3S %/t'Q�Ar,I't\J O /r4
owner: lk/c� uJ 1L\ f Tiy
Contractor Name: FXV%.0r5 11iNJrfr- f, {dunh0,1✓6
City Staff Name: 'DMIC, eA-J p00^
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: VO 111 '1,2
Building Permit #:
Encroachment Permit#: ?V, ?-7- -bb t 1
Cleanout Location:
Front
❑ Rear
❑
Left
❑
Right
Face of Curb
Lateral Size:
Cleanout: 9 Existing ❑ New Installation
Comments and/ or
Sketch:�/\(jl'('G�,Q� yi.7. N Vni�-�
W Lj:
Test Type: CO Water ❑ Air
Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year
Partial Repair Made 10 Year ❑
New Installation 25 Year ❑