HomeMy WebLinkAbout1125 Capuchino Avenue - SL - 2023.01.17 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: 11I,< bPv?kktM t.t D A^� • Tested Date: 1 ( n � V3
Owner: CUYr'p( 17 /e✓t.7 STyw-v-, 1 ,IL Gtm. TUr'r-3R Building Permit#:
Contractor Name: D\S Ltl U3; gLLAt`N4T Jle 1r'v. Encroachment Permit#: VgNV3- 0 0 1 P
City Staff Name: PMt t7 fJNt�>o H A
Cleanout Location: ❑ Front 7 Rear ❑ Left ❑ Right
Face of Curb
Lateral Size:
Cleanout: ® Existing ❑ New Installation
Comments and/ or
Sketch:
Test Type: 1,9 Water ❑ Air
N Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year (�
Partial Repair Made 10 Year ❑
New Installation 25 Year 13