HomeMy WebLinkAbout1426 Capuchino Avenue - SL - 2023.04.04 - 10 Yearstrt
City of Burlingame
G"ME' Public Works Department
Sewer Lateral Test Certificate
Address: 1�I 1, b CkPunkt INIr hvt;. Tested Date: t"I I y 12 .i
Owner. r`thbhTA r_o.�fl.l., f1 k %� rlh- Building Permit#:
Contractor Name: \c7 WF,tth{- CD.�yyf Al�cl(,1 Encroachment Permit#: VW'LS -0\1,6
City Staff Name: DX4NO Gyr&)Wn 'Pr
Cleanout Location: ❑ Front Rear ❑ Left ❑ Right
Face of Curb
Lateral Sze: `i Test Type: [ Water ❑ Air
Cleanout: EX Existing ❑ New Installation Status: Pass ❑ Fail
Commentsand! or
Sketch* WAIX, - -Ty7typiwi,Q
Sewer Lateral Condition: Exemption Type:
Nom air Needed 10 Year 121'
Partial Pa air Made 10 Year ❑
New Installation 25 Year 0