HomeMy WebLinkAbout1333 Laguna Avenue - SL - 2022.12.27 - 25 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: �t L ,d.v.a,.•l.s� �K.,,� �{-I�i� \ Tested Date: iZ I Z'1 LZ
Owner: t( -v/ ytN L -f Gl c5y Building Permit #: rlti t " n Li
(1.�
Contractor Name: ,f �`1 cb"- i'Y ✓ GSL U � Encroachment Permit
City Staff Name: la�,.t— Vt1�"2"�V�/ (
Cleanout Location: ❑ Front 211 Rear ❑ Left ❑ Right
Face of Curb
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Lateral Size:
Cleanout: ❑ Existing RY New Installation
Comments and/ or
ZQ Water ❑
Status: Rr Pass
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
❑
Partial Repair Made
10 Year
❑
New Installation
25 Year