HomeMy WebLinkAbout1040 Cortez Avenue - SL - 2023.06.29 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address:
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_ Tested Date: �9' �)� 124
Owner:
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Building Permit #:
Contractor Name:
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Encroachment Permit #:yj 1<3 - 011L fi
City Staff Name:
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Cleanout Locafion:
❑ Front
❑ Rear
❑ Left ❑ Right
Face of Corb
Sewer Lateral Condition:
Exemption Type:
Lateral Size:
''(
Test Type:
Water ❑
Air
Cleanout:
[Y Existing
❑ New Installation
Status:
0—Fall..-
FailComments
Comments and/ or
Sketch:
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
[y
__.._.._ _..
Partial Repair Made
10 Year
❑
New Installation
25 Year
❑