HomeMy WebLinkAbout1633 Lassen Way - SL - 2023.09.14 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: 1fors-� L54j y, t,pY Tested Date: 0411412')
Owner: C 44K (,y, Rte, 54-cLi Building Permit#: :PZ 3— O (z O
Contractor Name: T)� 3 )nwkvi Uu.h ffn4 Encroachment Permit Z7 - (JU I I
City Staff Name: -5gK(„, \YOHZrI\e 5
Cleanout Location: ❑ Front
42J Rear
❑
Left
❑
Right
Partial Repair Made
Face'of Curb
New Installation
25 Year 0
Lateral Size: y �N
Cleanout: ❑ Existing Z New Installation
Comments and/ or
Sketch:
Test Type: Water ❑
Status: ❑ Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year ❑
Partial Repair Made
10 Year +0'
New Installation
25 Year 0