HomeMy WebLinkAbout2120 Hale Drive - SL - 2022.11.04 - 25 YearsAddress:
Owner:
Contractor Name:
City Staff Name: ( ��
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date:
Building Permit#:
Encroachment Permit #:
I,( -.I-, 2-2--
2-2-
zZ2 -- J�::>J-+,
Cleanout location: ❑ Front X Rear ❑ Left ❑ Right
Gr
lateral Sze:
Cleanout: ❑ Existing New Installation
Commentsend( or
&etch:
Sewer Lateral Condition: Exemption Type:
Nom air Needed 10Year ❑
Partial Pbpair Made 10Year ❑
New Installation 25 Year
Testi e:
0 aler
❑
Air
Salus:
Pass
❑
Fail
Sewer Lateral Condition: Exemption Type:
Nom air Needed 10Year ❑
Partial Pbpair Made 10Year ❑
New Installation 25 Year