HomeMy WebLinkAbout1528 Bernal Avenue - SL - 2023.11.08 - 25 YearsCIty of Burllngame
Publlc Works Department
Sewer Lateral Test Certlflcate
Ad d ress:
Owner:
Conkactor Name
City Saff Na me:
4 Tested Date
Building Perm it #
Erc roac hment Permit #-
Cleanout Location E Front B- Rear tr teft @ nigrt
La te ra I Sze
Cleanout:
Commenlsand/ or
Sk6tch:
trt
E Existin8 Et-
Tesl Type fi- water tr Air
New lnstallation Satus:ts- pass tr Fail
Sewer Lateral Condltlon:Exem
No repair Needed 10 Year tr
PartiaIRepair l\/1ade l0 Year
25 Year ENew lnstallation
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