HomeMy WebLinkAbout1102 Balboa Avenue - SL - 2012.12.19 - 25 YearsCity of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address:
Owner:
Conlroclor Nome:
City Stoff Nome:
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Building Permil #:
Encroochment Permil #:
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Cleonoul Iocolion:I Front Rear
e of Curb
n Left n Risht
toterol Size:
Cleonoul:
Commenls ond/ or
Skelch:
tr Existing X ru"* tnstallation
Tesl Type:f *o,",tr Air
Slotus:}(ro,,tr Foit
Sewer Lateral Condition:
No Repoir Needed 10Year D
Porllol Repoir Mode 10 Year tr
New Inslollolion 25 Year X
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