HomeMy WebLinkAbout1037 Paloma Avenue - SL - 2023.02.14 - 10 Yearseuqu cwl�e
City of Burlingame
Public Works Department
Sewer Lateral Test Certifiratim
Address: V 11 IDA' Ox'\A A\/ \-, - Tested Date: 21 ',it Zi
Owner: SC1\141 tit.tn A M- N,\) Building Permit#:
Contractor Name: )n (ba/KL: C10 Kd�16(A-\0J Ir�L Encroachment Permit#: t>vJ'L 1--06 LI
City Staff Name: S'1 M\�7 fJtdl-0Ur�l1
Cleanout Location: ❑
Front
9 Rear
❑ Left
❑
Right
Face of Curb
10 Year 19
New Installation
25 Year 13
Lateral Sze:
Cleanout: R Existing ❑ New Installation
Commentsand/ or
Sketch: WAT\%J,. r \ -5 Qt , ,f!,A
Test Type: t5r' Water ❑ Air
Status: X Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No P—sair Needed
10 Year ❑
Partial Pa air Made
10 Year 19
New Installation
25 Year 13