HomeMy WebLinkAbout1357 Vancouver Avenue - SL - 2023.04.06 - 10 YearsAddress: \%,ti" Avi,
Owner. \4AALAw7 KATXA" N G L\'Lh ('DG -t•1.\
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: Li ( w ti3
Building Permit#:
Contractor Name: ATVAS OL.\AY\�bNy-l. 3�\1'I7U i��tt- Encroachment Permit#: 9\-/1-3 - () 1 2 2;
City Staff Name: CAAvyok iA
Cleanout Location:
❑
Front
® Rear
❑
Left
❑
Right
Face of Curb
Lateral Sze:
Cleanout: t5 Existing ❑ New Installation
Commentsand/ or
9cetch: \NfArl-pi0i TG'S1' PN -t ✓�7
Test Type: 19 Water ❑ Air
Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No air Needed 10Year 2!r
Partial Flaair Made 10 Year ❑
New Installation 25 Year 0