sanitaryCUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173
1:e4stfSMEOs:"4` CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter)
❑ Multi -Family Project Iommercial Project
Project Address: 10 ``i 30 S (:),
2lh \ V
Permit Number:j(.--S - Z3 `19 - G 0) 2--
Scope of Work: COf f \Q)( C l & SL T�1�c)c ( (1 loc(A,
Owner/Applicant Name: Phone:
Address: Email:
❑ Single Family Project
Date: C1-15" 161 Prepared By:
CiAy uthorized 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 -in section Required
Date Sche led:
❑ Final Insp tion Required
Date: Conditional Approval By:
Authorize Representative
Cupertino S nitary District
District will notify owner of the required fee within 5 days after Pre -Inspection has be completed and cc
City of Cupertino.
Fee Paid Date Paid:
Inspection - -s:
0 $400/un
$300/unit -
$800/unit -
$300/unit -
$600/unit -
0 $250/each
Plan Check Fees:
0 $300 - Lateral Plan Check
$800 - Grease Control Device Plan Chec
Change in Use Fees. Actual Amount:
Single Family Residential already connected, but new cleanout is required
Si . - Family Residential already connected with existing cleanout in working order
New La -I Installation with CCTV Included
Grease Trap ' pection
Grease Intercept • Oil Separator Inspection
- Disconnect and/or a. -ndon lateral service
Date: Final Approval By: 4 - .-v
r-s-D T Q.a LA( r-e f►�1�21 5
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Authorized a resentative
Cupertino Sa i ary District