HomeMy WebLinkAbout1217 Capuchino Avenue - SL - 2023.08.01 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: 1?- 11- CA- Pu" [^J ° Av-C Tested Date: , it 2 3
Owner: A C„rJ ArtA
1' 44 Afr Y�W ( L I PM-TNEIIE5 L1 Building Permit#:
Contractor Name: :d ” Cc 5A ke1;r ` a6ri S`�ZU C'P �t Encroachment Permit #:
City Staff Name: 3b �! MA Lb Q - l A U(6A-C
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Cleanout Location: ❑ Front Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: Test Type: Water ❑ Air
Cleanout: V Existing ❑ New Installation
Comments and/ or �ptGtf - r
Sketch: {� i 1
N a L- C3 S i .
Status: ❑ Pass ❑ Fail
Sewer Lateral Condition: Exemption Type:
LNo
Repair Needed 10 Year
Partial Repair Made 10 Year ❑
New Installation 25 Year ❑