HomeMy WebLinkAbout1432 Drake Avenue - SL - 2023.06.01 - 25 Years� CITY aT
City of Burlingame
aURLINGAME
Public Works Department
Sewer Lateral Test Certificate
Address:
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Tested Date: g>c //I(z
Owner:
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Building Permit #:
Contractor Name:
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Encroachment Permit #:
City Staff Name:
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Cleanout Location:
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❑ Front 2 Rear
❑ Left ❑ Right
Face of Curb
1 1 L
Lateral Size:���\
Test Type: -B—Water ❑ Air _
Cleanout:
JO Existing
❑ New Installation
Status: —f7— Pass ❑ Fail
Comments and/ or p u /�
Sketch: n GL/ If','4t tc r" qq .Y
_ Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year ,8'