HomeMy WebLinkAbout1633 Marco Polo Way - SL - 2023.05.23 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: \y'll MhAeao Pj;,Lt3 WN!j Tested Date: �2�123
Owner: T)N4\ W)" tl— Building Permit#:
Contractor Name: htL,AS VLiLAftl5i„�I— A✓{7 Encroachment Permit#:
City Staff Name: Qhs N'>
Cleanout Location: 14 Front ❑ Rear
❑ Left
❑
Right
Face of Curb
Partial Repair Made
10 Year ❑
New Installation
25 Year ❑
d
Lateral Size: � _ _ _ _
Test Type:
Wafer
❑ Air
Cleanout: ER Existing ❑ New Installation
Status:
Pass
❑ Fall
Comments and/or �Y
Sketch: Lt►` t U QP'{j�
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
Partial Repair Made
10 Year ❑
New Installation
25 Year ❑