HomeMy WebLinkAbout3072 Atwater Drive - SL - 2023.06.13 - 10 Years� w ctn
City of Burlingame
BURLINGAME
u Public Works Department
Sewer Lateral Test Certificate
Address: _ 3 o-7 /- ATwAT-p-iL- (-ft . Tested Dote: (1 1 LZ -7,
Owner,TS% /r)\1 YI{ry(., L) ryt 3'(!\J4 J\ 74- Building Permit#:
Contractor Name: '�j� ((. , j1���T e1 I Encroachment Permit #: PW 13 U Z '� 7
City Staff Name: j7 A-4
Cleonoul Location: Front ❑ Rear ❑ Left Right
Face of Curb
It
Lateral Size: Li Test Type: Y Water ❑ Air
Cleanout: Existing ❑ New Installation Status: 14 Pass ❑ Fail
Comments and/ or /��.�^�/, L
Sketch: WA T/\ TPi_11._-S��2Y<,7- __
Sewer Lateral Condition:
No Repair Needed
Partial Repair Made
New Installation
Exemption Type:
10 Year
10 Year ❑
25 Year ❑