HomeMy WebLinkAbout250 Park Road - SL - 2015.01.02 - 10 Years-CITY
City of Burlingame
RUNGAM�
Public Works Department
Sewer Lateral Test Certificate
Address: Tested Date:
Owner: Building Permit #.-
C
ontractor Nome: Encroachment Permit #.
City Staff Nome:
Cleanout Location: El Front 11 Rear it Left El Right
Face of Curb
Cleanout: U Existing El New Installationstatus: Pass Fa !
Test Type: Water Air
Sewer Lateral Conditiow.
Exemption Type:
No Repair Needed
10 Year
Pqrjtqtttepqi1r Model,
10 dear
11 New Installation
25 Year El