HomeMy WebLinkAbout1453 Burlingame Avenue - SL - 2015.01.02 - 25 Years'BURUINGAIME
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: Tested Date:
Owner: Building Permit #:
7T -
Contractor Name:
Encroachment Permit #:
City Staff Name:
Cleanout Loctiltow D Front 11 Rear 0 Left El Right
Face of Curb
0
Lateral size: ...... ..... Test Te Type:
Water El Air
Cleanout: CE Existing New Installation Status: Pass El Fail
,,,,CWnments and/ or
, �4-e
Ske�tch;
Sewer Lateral Condition; Exemption Tvpe:
No Repair Needed 10 Year 1:1
Partial Repqk!Mqqe_ 10 Year 1771
New Installation 25 Year