HomeMy WebLinkAbout833 Maple Avenue - SL - 2023.02.21 - 25 YearsA
GAME
Address: 0J3 -
Owner:
Contractor Name: Z/'W /� e, l [�.A!.:t
1
City Staff Name: , C.._Oyo%\„ e_�
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date:
Building Permit #: �1 �-t
Encroachment Permit #: ^�
Cleanout Location: ❑ Front ❑ Rear ❑ Left Cl Right
Face of Curb
J
Lateral Size: Test Type: Water ❑ Air
Cleanoul: Existing ❑ New Installation Status: Pass ❑ Fail
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year