B-2018-0473 Sanitary ApprovaluW `,gyp 81.XIT�gf�f
CUPERTINO SANITARY DISTRICT �[a—]
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173 '+Ba,aXEp'06 CUPERTMO
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: Loo
Permit Number: 2 — 7-p ( � - 6�a 3 v
Scope of Work: -? L L-D
Owner/Applicant Name: C-1 C-P &ab\ t, o r t G0.w- ly't,6 Vk hone: U0 E
Date: � Y- Prepared By:
1, 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
Date Scheduled:
Pr -"Final Inspection Required
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 C pe 0 o.
Inspection Fee Paid Date Paid: �- ' (�
Inspection 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
O $350 Minimum -Commercial and Retail Actual Amount:
0 $200/each - Disconnect and/or abandon lateral service
Connection Permit Fees:
O $350/unit - Single Family Residential connecting to existing lateral
0 $650/unit- Single Family Residential connecting with new lateral
$100/unit - Multi, Hotel, Living Units, etc. Actual Amount:
O $500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
O Area and Frontage Fees Amount:
0 Residential Excess Fees over 3.5 unit/acre Amount:
0 Commercial and Retail Connection Fees Amount:
O Commercial and Retail Change in Use Fees Amount:
Date: 3—�0 — I Final Approval By:
Authorized prese tative
Cupertino Sam ary District