1534 ,CUPERTINO, SANITARY'DISTRICT
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OFFICE OF THE DISTRICT MANAGER N 153
SERIAL 0 '.}
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i SE\iER COA7VECT /
L. I. DNNO ..
ION PE$hIIT
ASSES, o. . /1J ........
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f ,v+fir( ., 19VJ�/0
l >a I hereby,request that I be granted a permit to connect the property at . .-. ✓ - .VrO
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,rel ;u,,,<`,s•1`,Y. e/.i� ....�_ : - . .. ......., consisting of
��`Z RSP x aw Ty. ". ...
TYPE OF BUILDING) (One Family) ;(Duplex) (Commercial) (Other)
h ..
iry .. ... .. .. .... ....
.oto the sewer system within Cupertino Sanitary District
( 3zvtg, IAunderstand that all sewer construction and connections made or to be made on my private property must .
inspectedland approved by the County Building Inspector (CY 5-1050) BEFORE I BACKFILL THE TRENCH
-� OR'USE_THE
SEWER'. .
�� i r bmldmg stolto es nor�of8ces District
this lateral sewer'Cupertino Sanitary District prior to connecting any future
'
y I�understandtha itTunlawfulto discharge storm water or groundwater into.the sewerY
y, ••J.+rl [ 3 ? hIY �„ s'ise ). .
Twill check the existing lateral prior to)the +nctallatioa h of the house sewer to make sure that'sewage will
_p {-flow-through it to, the street maw„It is understood that if I fail to make this check or.to notify the District
•.P 'Manager prior to the installation of the bouse sewer of any defects in the flow characteristic'of the existing
I e-al, the District will be relieved of any responsibility for these defects 4
a {. r ,t(.3HY,J'0 1 JF r 4 D
'+ I amahe (d2eater-ef) the above described property.
= r
(9-km3xny Contractorfor)
- Owner's Name . �...:...1,1l�/� �Il.....
-
ayi. P In the e.-vent that this property,is sold,�� - - ,Pleas�l� rult)
rtheowner, to avoid becoming obligated for' .. . By .� �' = !�3,...Vf��. ✓�:t� �,---
q sewer
service ChargesCcramg.after date,:
s'
-,Y of sale on this roe must motif the Drs-• ling address if
different from above :�L'�i.. 1..... fI �..
P P rtyr y Billing C7
R , ,tnct.of the date of the sale and of the-
y.f <+':# 4,sew„owner's name and address.
' Phone............................................... ,."”"-”"
S 4
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't :;z, eeceipt.of connection fee of $5.00 and service charge of $. �...... . ..... for the period ending... ...... ..
-,
/ T
. ...... ........Q........ .... 1 (Total : .`":.....) acknowledged.
Permit granted subject to the conditions enumerated above and subject to.,regulations and ordinances
`';'adopted by the County of Santa Clara and by Cupertino Sanitary District.
In the event the above described sewer connection has not been installed b Gr+":.P .. -..-----
tZ x
this permit will become VOID, the total amount paid for the connection fee service charges will be f rfcited'
•.a.-:`• ' to. Cupertino Sanitary District, and a subsequent permit will be required install the above described sewer -
connection.
• MARK THOMAS & CO. .
District Manager t
_� � 18 North//S//an Pedro Street