HomeMy WebLinkAbout930 Laguna Avenue - SL - 2023.10.17 - 25 Years CITY City of Burlingame
" !X"' Public Works Department
Sewer Lateral Test Certificate
Address: _ � �Ct�f�f f ' Tested Date: f ["J t f->
Owner: Building Permit#:
Contractor Name: r }1.v_�'_ Lc�tht„ �-� ---___-- Encroachment Permit#: - � �
City Staff Name: rum
Cleanout Location: ❑ Front Rear ❑ Left ❑ Right
Face of Cuib
Lateral Size: Test Type: 3' Water ❑ Air
Cleanout: ❑ Existing New Installation Status: Pass ❑ Fail
Comments and/or
Sketch:
Sewer Lateral Condition: Exemption Type:
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
I
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New Installation 25 Year