HomeMy WebLinkAbout1311 Burlingame Avenue - SL - 2015.01.02 - 25 Yearssura
City of Burlingame
Public Works Department
a ••_
Sewer Lateral Test Certificate
Address: 2 Tested Date:
Owner: Building Permit#: a.
Contractor Name: Encroachment Permit##:
City Staff Name:
Cleanout Location: ❑ Front ❑ Rear ❑ Left ® Right
Face of Curb
Lateral Sze:.
Comments and/ or
Sketch:
❑ existing New Installation
- ,
Test p_S1
Water
❑
Air
Status:
Pass
❑
Fail