HomeMy WebLinkAbout14 Bancroft Road - SL - 2023.03.09 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: I I 84AJC"P'r k Tested Date: '31-112,3
Owner: 4�01612MAAI Ars%/a! !' TO 3eR?AI�h%61,91C'Lilding Permit#:
Contractor Name: jAAC L-1 p1 t- LS p1.-VMB7l✓C7 Encroachment Permit#:
City Staff Name: C 1 -r i At,)A -TA A UL W4 -y
fh/ 2,3 — 00 W
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
Face of Curb
Late raI Sze: Test Type: bRA Water ❑ Air
Cleanout: A Existing ❑ New Installation
Comments and/ or
Sketch: h / lt -W l/o
Pass ❑ Fail
Sewer lateral Condition: Exemption Type:
No Repair Needed 10 Year
Partial Repair Made 10 Year ❑
New Installation 25 Year 0