HomeMy WebLinkAbout340 Bloomfield Road - SL - 2023.04.13 - 10 YearsAddress: X,0bn'hr/LA> l,i>.
Owner: ktn NAQt1sJ
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: `{ 1 V5 i L3
Building Permit#:
Contractor Name: Q.WGy 'e-pt"J'F..V�t J Encroachment Permit#: —o) 10
City Staff Name: N)A-A 7 (Jc4A-7Ur'A
Cleanout location: ❑ Front ❑ Rear Left ❑ Right
Face of Curb
Lateral Sze:
Cleanout: LM Existing ❑ New Installation
Commentsand/ or
Test Type: 5' Water ❑ Air
Status: del Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Pe air Needed 10 Year
Partial Pe air Made 10 Year ❑
New Installation 25 Year ❑