HomeMy WebLinkAbout2309 Adeline Drive - SL - 2022.12.06 - 10 YearsAddress: 1-1A Pc57f L1r':i 17dL.
Owner: JA )UN/'(� Thy4 Nhr»y
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: 121 6 1 2 Z
Building Permit #:
Contractor Name: MA VA,PNF U Encroachment Permit#: Pw`LL-
City Staff Name: N)A4\<7 \->JNP
Cleanout Location:
❑ Front
ff Rear
❑
Left
❑
Right
25 Year ❑
Fate of Curb
,.h
Lateral Size:
Cleanout: M Existing ❑ New Installation
Comments and/ or �t
Sketch: WAIY'A' Tts'+ PA''75j/r
Test TVDe: M Water ❑
Status: P Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
Partial Repair Made
10 Year ❑
New Installation
25 Year ❑