HomeMy WebLinkAbout1321 De Soto Avenue - SL - 2021.04.15 - 25 YearsBU1UNGAME
Address:
City of Burlingame
Public Works Department
Sewer Lateral Test
Tested Date: LA I i 1
Owner: ��.�/ �a ��� �1 „ Building Permit #:
Contractor Name: Encroachment Permit #:
City Staff Name:
Cleanout Location: ❑ Front ❑ Rear ❑ Left ❑ Right
Pace of Curb
Lateral Size: Test Type: '�, Water ❑ Air
Cleanout: ❑ Existing New Installation
Comments and/ or
Sketch:
Status: �§< Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year ❑
Partial Repair Made
10 Year ❑
New Installation
25 Year