HomeMy WebLinkAbout818 Laurel Avenue - SL - 2023.05.11 - 25 Yearsw�l City of Burlingame
BURLINGAME Public Works Department
Sewer Lateral Test Certificate
Address: \ I _qV,r R\ Nsc mm- Tested Date: OSI r r l 2
Owner: R',ca„x.l S (. %%))A 0 Building Permit It: oIs Z3' O(2t
Contractor Name: 'S (Q 5,,- Cot sq.t6,) t" Encroachment Permit #:
City Staff Name: i.syt... Cso M1 --L`1
Cleanout Location: ,L+y rront ❑ Rear ❑ Left ❑ Right
Lateral Size: 40 Test Type: Water ❑ Air
Cleanout: ❑ Existing Rr 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