HomeMy WebLinkAbout2839 Mariposa Drive - SL - 2023.04.11 - 25 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address:T r�� jam, Tested Date: +''
Owner: �"�� Building Permit#:
Contractor Name: Encroachment Permit #:
City Staff Name: I
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
�r Face at Carb
Lateral Size: _ / Test Type: _ ater ❑ Air
Cleanout: ❑ Existing New Installation Status: Pass ❑ Fail__
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
.._. __._. New Installation 25 Year