HomeMy WebLinkAbout1515 Vancouver Avenue - SL - 2022.12.29 - 10 Years9
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: V/'Yt by\Av?p, /wq,
Owner: M'DT QS ("VV6G FYi �jAGUJTi �y\ if�y}
Contractor Name: i)' (�iNft1Y CUySsd-rt (T of TJ (.
City Staff Name: nhJ\xi [�Tj[}iiF
Tested Date: \ Z ) L'l 1 2Z.
Building Permit #:
Encroachment Permit #: ?W 2 Z - N. ( 1
Cleanout Location:
❑ Front
12 Rear
❑
Left
❑
Right
Face of Curb
Lateral Size:
Cleanout: -M Existing ❑ New Installation
Comments and/ or
Sketch: W/tS�Y StGSi �A SS FS,>. r� 5V1.l0DJLe
Test Type: La Water ❑ Air
Status: IT Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year LSF'
Partial Repair Made 10 Year ❑
New Installation 25 Year ❑