HomeMy WebLinkAbout1490 Oak Grove Avenue - SL - 2023.06.07 - 25 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: i/ L��Y� ` Tested Date: rj�iC `T 2j
Owner: Building Permit #: / -2J" e66,1
Contractor Name: / / Encroachment Permit #:
City Staff Name:
Cleanout Location: ❑ Front Rear ❑ Left ❑ Right
Face of Curb O/
Lateral Size: _ 1 Test Type: XJ Water ❑ Air _
Cleanout: ❑ Existing I 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