Sanitary LetterEnnlrngr—
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd#100,Cupertino,CA 95014 F121
Tel(408)253-7071•Fax(408)253-5173 sr9gl1SNE9,00 CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
Over-the-Counter)
Single Family Project Multi-Family Project Commercial Project
Project Address: W(o Z _F(aG 1L_i ti f7/2O( IDr,
Permit Number:
Scope of Work: f L
Owner/Applicant Name: 1 IPl(k hone. q/S-7q 7- 7
Address:
Date: Prepared By:
City Authorized Representative
I,as property owner or authorized agent,acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date: Signature:
Owner/Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
Pre-inspection Required Final Inspection Required
Date Scheduled:
Date: Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc
City of Cupertino.
Inspection Fee Paid Date Paid: 5-330- 1IR
Inpcti n Fees:
250/unit-Single Family Residential already connected,but new cleanout is required
150/unit-Single Family Residential already connected with existing cleanout in working order
350 Minimum-Commercial and Retail Actual Amount:
200/each-Disconnect and/or abandon lateral service
Connection Permit Fees:
D $350/unit-Single Family Residential connecting to existing lateral
D $650/unit-Single Family Residential connecting with new lateral
D $100/unit-Multi,Hotel,Living Units,etc. Actual Amount:
O $500/connection-Commercial and Retail Actual Amount:
Connection Use Fees(See Attached Calculation Sheet):
E=I Area and Frontage Fees Amount:
D Residential Excess Fees over 3.5 unittacre Amount:
D Commercial and Retail Connection Fees Amount:
O Commercial and Retail Change in Use Fees Amount:
Date: c3o - t;F- Final Approval By:
Authorized Rep* se tative
yCupertinoSanitaristrict