HomeMy WebLinkAbout1225 Vancouver Avenue - SL - 2023.07.25 - 10 Yearse cfn
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BURLINGpME
Address: \titi� VM,160(Ato-;), L hsrG
Owner: SiNM/k (-h-F\ 'CO -
Contractor Name: V!�i`L-k
City Staff Name: 'bpcV \S? (4,0620
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: )17 s I Z;
Building Permit #:
Encroachment Permit #: PW 4-3 ^ OL -'i 7
Cleanout Location: M Front ❑ Rear
lace of Curb
❑ Left
❑
Right
tr
Lateral Size:
Test Type:
Water
❑ Air
Cleanout: Existing ❑ New Installation
Status:
Pass
❑ Fail
Comments and/ or
Sketch:
Sewer Lateral Condition:
No Repair Needed
Partial Repair Made
New Installation
Exemption Type:
10 Year
10 Year ❑
25 Year ❑