HomeMy WebLinkAbout2505 Hale Drive - SL - 2023.07.11 - 10 YearsAddress: �Gj faS ��h �, Fi MV
Owner: LO LA IAMV1 b47A' n NO) -I?? ?f fi Mn
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Contractor Name: n CleSAaf�✓ CJSS
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City Stall Name: ' ok-4 ID
City of Burlingame
Public Works Department
Sewer Lateral Test Certificate
Tested Date: 71111/2,3
Building Permit #:
Encroachment Permit #: pW'f- -3 - 0 21 it
Cleanout Locailon:
❑ Front
Rear
❑
Left
❑
Right
Face of Curb
Lateral Size:
Cleanout: Existing ❑ New installation
Comments and/ or
Sketch:
_ Test Type:_ - — X Water ❑
Status: _ tR Pass ❑ Fall
Sewer Lateral Condition: Exemption Type:
No Repair Needed _ 10 Year
Partial Repair Made 10 Year ❑
New Installation 25 Year ❑