HomeMy WebLinkAbout1223 Burlingame Avenue - SL - 2015.01.02 - 25 YearsCITY
V
City of BurlingameV
Public
Sewer Lateral Test Certificate
Address:
„ �.__._
Tested gate: ?,
_
Owner:
Building Permit #: CAi
Contractor Name:
'° ; -
Encroachment Permit #:
City Staff Name:
Cleanoui Location:
❑ Front ❑ Rear
❑ Left C7 Right
Face of Curb
Lateral Size:
m r.q
Test Type: Water l Air
Cleanout:
El Existing �' New Installation
Status: Pass ❑ Fail
Comments and/ or
ein:a.
.c
F. =....
Sewer Lateral Condition; Exemption Ty;
No Repair Needed 10 Year ❑
>
A
❑
- _ :w
Partial Repair Made 0 Year
New Installation 25 Year