HomeMy WebLinkAbout1517 Balboa Avenue - SL - 2024.03.11 - 10 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
ISll ?-,J!,ooAddress:
Owner:
Controclor Nome:
City Sloff Nome:
Tesled Dole:
Building Permil #:
Encroochmenl Permil #:
Cleonoul Locolion:kFront D Rear D Left tr Right
[oterol Size:
Cleonout:
Commenls ond/ 01
Skelch:
Fo
X ,*,.on, tr New tnstallation
#*o,.,tl AkTesl Type:
Slolus:};,o,,tr Foit
Sewer Lateral Condition:
No Needed 10 Year
Portiol Repoir Mode 10 Year tr
New lnslollolion 25 Year D
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