5118221482 I Elm Court LOT NO.
NO. STREET
6"
AT0-611ICATION:,FOR PLUMBING PERMIT
C?ITY OF CUPERTINO
r-- sanitary No.
AUG 13 1968 _
Date Allqu/�st 7 p n 196 68 Permit No � �� S- --
r!TY Cf QQPER�i�lo Pee $ c..T 3Zi
Application is hereby made o the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Residence
Owner Tom Harris Address 21482 Elm Court
By Culligan Address 611 University
CONTRACTOR,AGENT Los Gatos, Calif.
Phone 354-1845
State License 216217 Approved �i l
r, PLUMBING INSPECTOR
FI` cNfrn I NUMBER MAIN D-?-,VN--w
UNITSI FEES 11 UNITS
Water Closet
Shower
To Prop. Line
Lavatories
To Existin
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
DRAINA
Machine
Comb.SinUTray I To Curb
Dental Unit
Area Draih ' Main Drain Fee _I
Water Leader p Storm Drain Fee
Sprink r Valve' A Water Sys. Fee
i 11 Permit Fee
Total Total Fee 1 3.50