HomeMy WebLinkAbout1151 Rosedale Avenue - SL - 2023.07.11 - 10 YearsA
Address:
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Owner: \tiAp �P PPttl it f J T(L/trJ N\�—h
Contractor Name: S@^G�I.W N FiL� S PLtq Yt '�J\ JLC
City Staff Nome: T)R^INx7
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: 711 t I "L 3
Building Permit #:
Encroachment Permit #: PW 1-3 - O Z 6 r?
Cleanout Location:
❑ Front ❑ Rear
15�- Left
❑
Right
10 Year ,�a
Face of Curb
Partial Repair Made
10 Year ❑
New Installation
25 Year 0
Lateral Size:
1`11
4
_Test Type:____
'U Water
❑ Air
Cleanout:
Existing ❑ New Installation
Status:
Aff Pass
❑ Fall
Comments and/ or
Sketch:
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cFh:- �2S�G :__ G k"Y CJ.L>
Sewer Lateral Condition:
Exemption Type_
_ _
_ _
-_No Repair Needed
10 Year ,�a
Partial Repair Made
10 Year ❑
New Installation
25 Year 0