HomeMy WebLinkAbout1128 Vancouver Avenue - SL - 2023.01.26 - 25 Yearsa
Address:
Owner. /I'
ContractorName:
City Staff Name:
Cleanout Location: ❑ Front
t't
Lateral Sze:
Cleanout: ❑ Existing VIN.. installation
Commentsand/ or
Sketch:
Rear
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: I ' _& .' — r
Building Permit#: ��Z( — oco
Encroachment Permit#:
❑ Left
❑ Right
Sewer Lateral Condition: Exemption Type:
No Paair Needed 10 Year ❑
Pa rtial Pope ir Mad a 10 Year ❑
New Installation 25 Year o2/
Test Type:
Wafer
❑
Air
Status:
110510, Pass
❑
Fail
Sewer Lateral Condition: Exemption Type:
No Paair Needed 10 Year ❑
Pa rtial Pope ir Mad a 10 Year ❑
New Installation 25 Year o2/