HomeMy WebLinkAbout327 Primrose Road - SL - 2015.01.02 - 10 YearsCITY City of Burlingame
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Public Works Department
Sewer Lateral Test Certificate
Address: Tested Date:
Owner: Building Permit #:
ContractorName: Encroachment Permit #: V2�
City Staff Name:
Cleanout Location: Front 1:1 Rear Left ❑ Right
Face of Curb
LateralSize: C'Test Type: Water 0 Air
Cleanout: El Existing Cl New finstaHation Status: Pass Fail
Comments and/ or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year El
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Partial'Repair Made 10 Year
New Installation 25 Year El