HomeMy WebLinkAbout1725 Sebastian Drive - SL - 2023.04.10 - 25 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address:
\�1 L`, 'i
,.-\�-�IN Vi
Tested Date:
>..t� �io�1 j
Owner:
1 ( Y
if '�ti,, ,.} (J
Building Permit #:
t 1 ; �_,
Contractor Name:
p c 4-f : `
R •J"
Encroachment Permit #:
PJ Z % - % \ i j
City Staff Name: -1..,;r.. l " 1 ha
Cleanout Location: ❑ Front ❑ Rear ❑ Left - ❑ Right
Face of Curb
Lateral Size:
Cleanout: ❑ Existing ❑ New installation
Comments and/ or
Sketch:
Test Type: Z Water ❑ Air
Status: ❑ Pass ❑ Fail
Sewer Lateral Conditiow
Exemption Type:
No Repair Needed
10 Year ❑
Partial Repair Made
10 Year _. ❑
New Installation
25 Year ❑