HomeMy WebLinkAbout1522 La Mesa Drive - SL - 2023.04.11 - 10 YearsAddress: I J ZZ LA MESA
Owner: r' fe 0 15AIt LA04A (, T R
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: 4.
.4L Building Permit#:
Contractor Name: D150ytLr--t PL -y Mbr-J4i j12t>Tt—Q Encroachment Permit#: / W �3 —0) 11
City Staff Name: �DRN 1�� A _TA V L 6&'-d
Cleanout location:
❑ Front �R Rear
❑ Left
❑ Right
Face of Curb
Late raI Sze:
Test Type:
u Water ❑ Air
Cleanout:
❑ Existing Newlnstallation
Status:
Pass ❑ Fail
Comments and/or
:ketch: X11 r � , i�TV TtW Ph< SG f
o wR LU s s
Sewer Lateral Condition: Exemption Type:
No Paair Needed 10Year
Partial Repair Made 10 Year ❑
New Installation 25 Year 13