P-15453 (2) CUPERTINO SANITARY DISTRICT PERMIT P-15453
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
Cupertino,California 95014
Phone (408)253-7071
(9 e3
CONNECTION PERMIT
(�- 3 -610
R.O.S./P.M./Tract No. Lot No. � II �(
A.P.N.: Book .3 1 (., I Page EJ / Parcel Date ydeL4,C It
Property Owner: / beh&1) (�- j.h J
Mailing Address:.//(1.1/ &,siei l_. 5, e /C'C-
(If different) 6CticIa(�.�Lc-bit) (A
Telephone: `+ -�-•r✓�L. /
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
ZL-' %� ,� �� �� cL •�fn"t C �f--r it C. � �Fi rJ Esti••�( 1`t (7
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family X _; Multiple Family ; No. Units
Commercial ; Industrial ; Other ; No. Units
do hereby request a permit to connect to the sewer system of the Cupertino Sanitary District.
IN CONSIDERATION OF THE GRANTING OF THIS PERMIT,THE OWNER AGREES:
1. To comply with all existing Ordinances, Rules and Regulations of the Cupertino Sanitary District as now or hereafter amended.
2. To maintain the House Sewer(that portion of the sewer within private property) which includes a cleanout (raised to grade and
accessible) located at the point of connection with the Lateral Sewer (that portion of the sewer in the street right-of-way or
District Easement). � /-
3. To acquire a Plumbing Permit from the �/.-rJ— of c.t.'/ =(T"•c't�' Building Department and obtain
inspection and approval by said Building Department prior to covering of the work or use of the sewer.
4. To first expose and inspect for serviceability the Lateral Sewer (that portion of the sewer within the street right-of-way or
easement), prior to starting construction of the House Sewer.
5. That this permit does not constitute a request for the issuance of an encroachment permit for sewer construction in the
street/public right-of-way of the agency having jurisdiction thereover.
6. To call Underground Service Alert(USA) 1.800-227-2600, at least 48 hours prior to starting grading or digging operations.
SPECIAL PERMIT CONDITIONS(Exhibits):
A BACKFLOW Protective Device shall be installed on the above property by the owner. Type of device and installation
shall comply with the Plumbing Code Requirements of the jurisdiction shown in 3 above.
FEES:
Connection Permit Fee: $
7
7
Sewer Service charges to June 30, 19 LL, $ /mo. x mo.: $
Inspection Fee for backflow protection device:
o/ .
Considerations and Restrictions of this Sanitary Sewer Connection Permit with attached Exhibits (when noted), are hereby agreed
to and acknowledged by the undersigned Owner(or Owner's Agent). Failure to comply will void this permit.
Acknowledgment:
7
Owner's Agent: Lee l o ii
( rint name)
Receipt of$ �/T acknowledged and permit granted.
MARK THOMAS & CO., INC., District Manager-Engineer
by
Aother
Note:See Detailse of this ermit.