HomeMy WebLinkAbout1447 Burlingame Avenue - SL - 2015.01.02 - 25 YearsSUALIMAME
City •i g.
Public Works Department
Sewer Lateral Test Certificate
Address: Tested Date: i
Owner: Building Permit#:
Contractor Name:
Encroachment Perrnit#:
City Staff Name:
Cleanout Location; El Front L1 Rear El Left El Right
Face of Curb
I I
Lateral Size:
Cleanout: El Existing New Installation
Test Type: Water Air
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10"Year --,
Partial Repair Made
10 Year
New Installation mm
25 Year