HomeMy WebLinkAbout1465 Burlingame Avenue - SL - 2015.01.02 - 25 YearsC ITY
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: Tested bate:
Owner: Building Permit #:
Contractor Nome: d Encroachment Permit #: �
City Staff Name:
Cleanout Location:
❑ Front ❑ Rear
Face of Curb
❑ Left
❑ Right
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I.aterar5lze:�'
Test Type: ,._.... _..__.
Water ❑ Air
_....... __..._...
Cleanout:
❑ Existing
New installation
Status:
Pass ❑ Fail
Comments and/ or
Sewer Lateral Condition:
Exemption Type.
_....-
`t
No Re arr Needed
10 Year
Partial Relaair Made
10 Year ❑
New Installation
25 Year