HomeMy WebLinkAbout1116 Drake Avenue - SL - 2011.06.02 - 25 Yearsa
Address:
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date:
Owner: Building Permit #:
Contractor Name: ^ �(O Clr Encroachment Permit #:
City Staff Name:
Cleanout Location:
❑ Front ❑ Rear
❑ Left
❑
Right
race of Carb
Lateral Size:
Test Type:
/�L9/, Water
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❑ Air
Cleanout:
❑ Existing New Installation
Status:
FJ1 Pass
11Fail
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year