HomeMy WebLinkAbout1121 Burlingame Avenue - SL - 2015.01.02 - 25 YearsCITY"
RUJRIAtj'�AMIE
City of Burlingame
Publ�ic Works Department
Sewer Lateral Test Certificate
Address:
Tested Date:
Owner: Building Permit
Contractor Name: Encroachment Permit #:
City Staff Name:
Cleanoul Location: E] Front U Rear 11 Left El Right
face of Curb
Cleanovt: El Existing I r New Installation
Test Type: Water ❑ Air
Pass ❑ Fall
Sewer Laterai Condition:
ed 10 Year El
—11.1-- ... ... .... . . -11-1--l-11
rip 10 Year El