P 11675 - SEWER N M
SEWER CONNECTION PERMIT
SERIAL NO.
•, CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd.
LID No.............Parcel No............I. Room 204 )406) 253-7071' P 1.1.675
Tract No.74 /P..-7 Lot No------1..... Cupertino, Ca., 95014
A.P.N. Bit..-----...-- Pg---......... Par.------..... Date...... ..�. -------/...................—......, 19.45
The undersigned, being the owner (or owner's agent) of the property located at..................................................
-Po( Le Vr , VC_
........-..................................................................................................................................................................................................
consisting of the following TYPE OF BUILDING:
Residential: Single family .. ..... Multiple .x.. No. Units--S.....
Commercial ........ Industrial -------- Other ...................................... No. Units------.....-
does hereby request a permit to connect to the sewer system of the Cupertino Sanitary District.
In consideration of the granting of this permit, the undersigned agrees: ~.t
1) To comply with all existing regulations and Ordinances of Cupertino Sanitary District and all future
regulations and Ordinances which may be adopted.
2) To maintain the house lateral, that portion of the side sewer within private property, and to provide
access to the lateral sewer through a cleanout raised to grade at the property line or at the limits of
any existing District easement.• ff / 1 3) To acquire a permit from the .-Ct n........6.1.......4�.P.�_!! D-------------:........... Building Depart.
ment and obtain inspection of and approval by said Building Department prior to covering of the work
or use of the sewer. Note: End of street lateral sewer must be exposed first
Lcl�rc scart.,;g construction of house la(�teral. y�
In the event this sewer connec- Property Owner's Name 4.x.1. .n�h7t�.t-�n <e,u4pt TiMOA 1-t,
tion is not installed and the permit Mailing address if ��C'n IT6'+'t'7G5�P/aC'� f.�cl f.Sc r// /1
different from above 4<, e^��/,
VOIDED, the fees receipted below ................---.........................__.......
shall be forfeited and a subsequent Telephone . 9G � 5—z
....................... ....................................
permit required.
By
r
FEES:
Connection Permit Fee (Soil, $
no
Sewer Service charges to June 30, 19g4� ($..7"-t...../mo. x.lr..mo.) -.............................'
Inspection Fee for backflow protection device .
................Additional Dwelling Units at $........................lea. (Zone No.........) ...-..........................
eV
l/ 00
TOTAL $...;03.:..
r� Receipt of $..-x`..^.1.3.. .. acknowledged and permit granted.
MARK THOMAS & CO. INC.
N OTE: District Manager_Engineer //r1
NO physical connection of the house sewer E / /.� /�y'�'G.(
to the lateral sewer shall he made until writ- /i/
ten permission is received from the District. By - --- -• ---- ----- --- -- -- •- -....- ----..