HomeMy WebLinkAbout2613 Martinez Drive - SL - 2023.09.15 - 25 YearsM
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: l,G15s *rk,w Z Dv:vc Tested Date: 01 / /5/ 7'7
Owner: VC Ew' CLV Building Permit#: :F2,3 - a it.,
Contractor Name: O(0 IPfJ ��V r..biw3 Encroachment Permit#: -v*- 0Yt42
City Staff Name: J 4kc- ("J.- ZA c.o'
Cleanout Location:
❑ Front
M' Rear
❑
Left
❑
Right
Partial Repair Made
face of Curb
New Installation
25 Year .Br
t
Lateral Size: L_1 \
Cleanout: ❑ Existing New Installation
Comments and/ or
Sketch:
Test Type: .rs! Water ❑ Air
Status: Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year ❑
Partial Repair Made
10 Year ❑
New Installation
25 Year .Br