City Of Milpitas
455 East Calaveras Boulevard,Milpitas,CA95035-5479 - Tel. 408.586.3240, Fax 408.586.3285
www.ci.milpitas.ca.gov
Tenant Name:
SEWER NEEDS INQUIRY
(For Non-Residential Applicants)
Tenant Address to be occupied:
Phone No:Contact Name:
Description of work to be performed under this permit:
Please answer each question listed below:
• Adding new plumbing fixtures?
• Adding new process equipment, which uses water?
• Expanding your facility?
• Creating a new shell space?
• Creating a new tenant space?
• Increasing the number of employees now or in the future?
• Changing the type of use of this space (for example from office to restaurant, medical office,
gas station, manufacturing, etc.)
• Tenant new to this space?
The information contained herein is familiar to me and to the best of my knowledge, accurate and complete. Additional
treatment plant fees will be required if monitored flow exceeds estimate based on information contained herein.
Applicant's Name (print): Title:__________________________
Signature:_______________________________________________ Date:_______________________
Company Name:
January 2010
Page 1 of 1
OFFICE USE ONLY
Shell Address: Building Permit #:
Phone No:
