HomeMy WebLinkAbout1413 Balboa Avenue - SL - 2023.08.23 - 10 YearsAddress: `� B i iw 084 H.IL VruP
Owner: O�I. MrA-W \A\12��I
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Contractor Name: aCC \C, 11 o LT.b
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City Staff Name: 5a4C[. C �p'\g ZAP
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: 031 ZS 1 2 t
Building Permit #: 0 k Do,
Encroachment Permit It: her.A�
Cleanout Location:
❑ Front
❑ Rear
❑
Left
❑
Right
Face of Curb
Lateral Size: 4 �l
Cleanout: ❑ Existing New Installation
Comments and/ or p r f
Sketch:
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Test Type: ;a Water
Status: 10 Poss
❑ Air
❑ Fail
Sewer Lateral Condition: _ Exemption Type:
No Repair. Needed 10 Year ❑
Partial Repair Made 10 Year $
New Installation 25 Year 0