HomeMy WebLinkAbout1308 Burlingame Avenue - SL - 2015.01.02 - 10 YearsE
"CITY", City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: -„ _ Tested Bate:„
Owner: Building Permit #:
Contractor Name: � Encroachment Permit tf:
City Staff Name: ,
Cleanout Location: ® Front 0 Rear El Left Right
Fac e at Curb
tt
Lateral Size: Test Tyree: Water.. CI Air
Cleanout: 0 Existing ® New installation Status: 1 Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year
Partial Repair Made
10 Year
New Installation
25 Year