HomeMy WebLinkAbout1475 Burlingame Avenue - SL - 2015.01.02 - 25 YearsCity of Burlingame
�URUtJ AM Publig Works
WSewer' Lateral Test Certificate
Address: F d.. } Tested Date:
Owner: � Building Permit #:
Contractor Name:
r _ Encroachment Permit #:
City Staff Name:
Cleanout Location: [❑ Front ❑ Rear ❑' Deft U Right
Face of Curb
Lateral Size: Testi e: Water ❑ Air
Type:,
Cleanout: I❑ Existing New Installation Status: Pass Fail
Comments and/ or
� ") Sewer Lateral Condition: Exemption Type:.
__ ... No Repair heeded 10 Year
m Partial Repair Made10 Year
r
I
_....... _ _.. _.,. New Installation 25 Year i