HomeMy WebLinkAbout1516 Newlands Avenue - SL - 2023.05.23 - 10 YearsCity of Burlingame
BURLJNGAME Public Works Department
Sewer Lateral Test Certificate
Address:
1 5 1(o V EO L-yow AS AVE Tested Date: 5 /'_- 3 / 2 3
Owner: WA L D C� j= Lp P- 1 N E 1e- Building Permit #:
Contractor Name: ISC6V W1- LUM1fi/J(1 Encroachment Permit #: t N Zai V i 9 L
City Staff Name: IbM MALaP--,fALJLE.ALJ
Cleanout Location: w Front 1:1 Rear El Left El Right
•` Face of Curb
Lateral Size:
Cleanoul: Existing ❑ New Installation
Comments and/ or .may
Sketch: W�1 oL
Test Type: _ Water ❑ Air
Stns is El Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
No Repair Needed _ 10 Year 0-
Padial Repair Made 10 Year ❑
New Installation 25 Year ❑