HomeMy WebLinkAbout1028 Chula Vista Avenue - SL - 2023.09.28 - 25 Years City of Burlingame
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Public Works Department
Sewer Lateral Test Certificate
Address: + Tested Date: C?
Owner: Building Permit If:
Contractor Name: .-�,. _ _ �•.� Encroachment Permit#:
City Staff Name:
Cleanout Location: El Front Rear ❑ Left ❑ Right
Face of Curb
Lateral Size: Test Type: Kl!�,Woler ❑ Air
Cleanout: ❑ Fx1sting New Installation Status: Pass ❑ Foil
Comments and/or
Sketch:
Sewer Lateral Condition: Exemption'Type:
I
No Repair Needed 10 Year ❑
Partial Repair Made 10 Year ❑
New installation 25 Year