HomeMy WebLinkAbout2116 Hale Drive - SL - 2022.09.20 (10)g
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Address: til It, LAk1k ma— Tested Date: q 101 7.,Z
Owner: Building Permit #:
Contractor Name: -MO" Encroachment Permit#: PW 7-7-- ()S7 -M
City Staff Name: T)Ar+TD Ur4oL7 wpf
Cleanout Location:
❑ Front
❑ Rear
❑
Left
❑
Right
25 Year ❑
Foce of Curb
Lateral Size:
Cleanout: ❑ Existing 19 New Installation
Comments and/ or
Sketch: W%)r�i�'�'j✓1 PA-SrXri• 1� �r,/%5i"h�
Test Type: ,m Water ❑ Air
Status: ,ro" Pass ❑ Fail
Sewer Lateral Condition:
Exemption Type:
No Repair Needed
10 Year lb
Partial Repair Made
10 Year ❑
New Installation
25 Year ❑