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2533 Hayward Drive - SL - 2022.09.21 (10)
Address: 1,533 VkAyWAdj) 17�. Owner: (�< l e�Pt iiA ��ti kril l Y City of Burlingame Public Works Department Sewer Lateral Test Certificate Tested Date: - I l %i I i 11 Building Permit #: Contractor Name: YD CXA.� 1r,('. Encroachment Permit#: V)W City Staff Name: b A411> &A,4q->t3,-%/¢ Cleanout Location: It Front ❑ Rear 0' Left ❑ Right Face of Curb Lateral Size: L, n Cleanout: Ia Existing ❑ New Installation Comments and/ or ` I Sketch: L,V-71 Test Type: © Water ❑ Air Status: IR Pass ❑ Fail Sewer Lateral Condition: Exemption Type: No Re air Needed 10 Year 0 Partial Repair Made 10 Year ❑ New Installation 25 Year ❑