HomeMy WebLinkAbout443 Marin Drive - SL - 2023.07.25 - 10 YearsCleanout Location: Front ❑ Rear ❑ Left ❑ Right
face or Curb
Lateral Size: _ Test Type: '2�_ Water__ ❑ Air _
Cleanout: "� Existing ❑ New Installation Status: ;q 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 ❑
City of Burlingame
BURLWGFME
Public Works Department
Sewer Lateral Test Certificate
Address:
�I 1
h/�Qis J '�(L,
Tested Date: %
Owner:
IiA'O�/t'Y�Ar-�
AJ �LY Y-� g Jf �✓�/
L Building Permit #:
Contractor Name:
16(.UtA_>T
Encroachment Permit#: QW1-3- A[i0
City Staff Name:
DMN 7
eAA'Dyr�A
Cleanout Location: Front ❑ Rear ❑ Left ❑ Right
face or Curb
Lateral Size: _ Test Type: '2�_ Water__ ❑ Air _
Cleanout: "� Existing ❑ New Installation Status: ;q 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 ❑