HomeMy WebLinkAbout1134 Clovelly Lane - SL - 2023.09.05 - 10 Years CITY
11City of Burlingame
UNGA
BURME
Public Works Department
Sewer Lateral Test Certificate
t
Address: uTested Date:
Owner: j
j Building Permit#:
A
Contractor Name:
Encroachment Permit 0:
City Staff Name:
Cleanout Location: 0 Front ❑ Rear ❑ Left El Right
Face of Curb
"A
VN
Lateral Size: Test Type: I Water ❑ Air
Cleanout: Existing El New Installation Status: IU- Pass El Fail
Comments and/or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year El
New Installation 25 Year 0