HomeMy WebLinkAbout2815 Tiburon Way - SL - 2023.06.07 - 25 Years� CITY
I City of Burlingame
aURLINGAME Public Works Department
Sewer Lateral Test Certificate
Address: O -(f' 5 T) liqJ'7`o A Tested Date: p® 0-7 i
Owner: J 01"5— L L A n j Building Permit#:! J'j
Contractor Name: nr:'L.aS Phi h b I Mh yN. dt A t ( Encroachment Permit #: Joj f13 — 10 2Z y
City Staff Name: 5G4CC iS U,,Z`^ t:�
Cleanout Location: ❑ Front XQ Rear ❑ Lek ❑ Right
Face of Curb
Lateral Size: k U Test Type: Water ❑ Air
Cleanout:
Comments and/or
Sketch:
❑ Existing d" New Installation
Status: �0 Pass ❑ Fail
Sewer Lateral Condition:
No Repair Needed
Partial Repair Made
New Installation
Exemption Type:
10 Year ❑
10 Year ❑
25 Year Rr