HomeMy WebLinkAbout1476 Burlingame Avenue - SL - 2015.01.02 - 10 Years. ITY,
�Public
City_Burlingame
Works
Sewer Lateral Test Certificate
Address:
Tested Date:
Owner:
Building Permit#: Ceq o-,
Contractor Name:
Encroachment Permit
City Staff Name:
Cleanout Location:
❑ Front ❑ Rear
❑ Left ❑ Right
Face of Curb
Lateral Sze:
I+
Fest Type: Water L] Air
Cleanout:
❑ Existing ❑ New installation
Status: Pans ❑ Fail
Commentsandl or
acetch
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Sewer Lateral Condition: Exemption Type:
_
No Fbair Needed 10 Year
Partial Fiepair Made 10 Year
New Installation 25 Year ❑