HomeMy WebLinkAbout1123 Oxford Road - SL - 2023.04.28 - 25 YearsC4U.RL°City of Burlingame
AME Public Works Department
Sewer Lateral Test Certificate
Address: I I / UT ev /W Trot ,I nntc ' -? •L
Owner: �r Iv—'2-3— v,Ud
Building Permit #:
Contractor Name: Encroachment Permit #: FN2Z —C
City Staff Name:
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: _T /New
Test Type: 4—Water 11Air
Cleanout: L1Existing nstallation Status: Pass ❑ Fall
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year Yl