Sanitary_2CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 - Fax (408) 253-5173
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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: ��� b?
Permit Number:
Scope of Work: o f
Date:
1, as property owner or authorized agent, aI
will be met nd li re ired fees will be paid
Date: g ( 'I Signature: -a,z
Phone:
that all Cupertino Sanitary District requirements
approval of final inspection for proposed project.
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:
Ins ectio Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
f� $150/unit - Single Family Residential already connected with existing cleanout in working order
O $350 Minimum — Commercial and Retail Actual Amount:
0 $200/each — Disconnect and/or abandon lateral service
Connection Permit Fees:
0 $350/unit - Single Family Residential connecting to existing lateral
O $650/unit— Single Family Residential connecting with new lateral
O $100/unit —Multi, Hotel, Living Units, etc. Actual Amount: _
0 $500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
O Area and Frontage Fees Amount:
O Residential Excess Fees over 3.5 unit/acre Amount:
O Commercial and Retail Connection Fees Amount:
Commercial and Retail Change in Use Fees Amount
Date: S— I Final Approval By:
V Authorized Re resentative
Cupertir6Sai tart' District