HomeMy WebLinkAbout210 Bayswater Avenue - SL - 2023.01.24 - 25 Yearsa
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: —Vk O '?:),YS ojcxk /'� Tested Date: 2`(( 1'�,
Owner: Gk01•,3 IT°lC�w� L -Vq-�WtcO �'l�et,^Z2- o�LfI
Building Permit #: `� R
Contractor Name: C -e PC�a �Iy 1«biw) Encroachment Permit#:
i
City Staff Name: 'SCWL—
Cleanout location: . PT Front
❑ Rear
❑
Left
❑
Right
Face of Curb
Partial Pe air Made
10 Year ❑
New Installation
25 Year 4r
Lateral Sze: Uk �s
Cleanout: ❑ Existing efY New Installation
Commentsand/ or
Sketch:
Test Type: 115 Water ❑ Air
Status: of Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
Nom air Needed
10 Year ❑
Partial Pe air Made
10 Year ❑
New Installation
25 Year 4r