HomeMy WebLinkAbout466 Marin Drive - SL - 2024.04.09 - 25 YearsCity of Burlingame
Public Works Department
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Sewer Lateral Test icate
Tesled Dote:
Building Permit #:
Encroochmenl Permil #:
tr Left n Right
Address:
Owner:
Conlroclor Nome:
City Sloff Nome:
Cleonoul Locolion:$ront n Rear
Foce oI
Lolerol Size:
Cleonoul:
Commenls ond/ or
Skelch:
}( *o,",tr AirTesl lype:
Slolus:! Existing ( *"* lnstallation tr Foit
Sewer Lateral Condition:
No Needed 10 Year tr
Portiol 10 Year D
New lnstollolion 25 Year ><
prqrt
lxlmption ]yqet IIt-