HomeMy WebLinkAbout12 Valdivia Court - SL - 2023.02.22 - 25 YearsCity of Burlingame
BUR`'"G,E Public Works Department
�' �..•.• Sewer Lateral Test Certificate
Address: Tested Date: �q'2'Z •2
Owner:e1,Ar Building Permit#:'
Contractor Name: Yl i� ,t Encroachment Permit #:
City Staff Name: /\
Cleanout location:Front ElRear 11Left ElRight
Face of C ,/,/
Late raI Sze: h TestType: 117 ater ❑ Air
Cleanout: ❑ Existing New Installation Status: Pass ❑ Fail
Comments and/ or
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New Installation 25 Year