HomeMy WebLinkAbout1151 Rosedale Avenue - SL - 2023.03.20 - 25 Yearsa
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: I �> I 1�� r�1 Y IC Tested Date: -3 - �" 2'3
Owner: Building Permit#: IG21'0057
Contractor Name: Encroachment Permit #:
City Staff Name:
Cleanout Location: ❑ Front
lateral Sze: K
Cleanout: ❑ Existing New Installation
Comments and/ or
&etch:
❑ Rear
Left ❑ Right
C
Status: ® Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Fle air Needed 10 Year ❑
Partial Pa air Made 10 Year ❑
New Installation 25 Year