P-15659 q
�"PERMIT P-15659
A
�"WPERTINO SANITARY DISTRICT.
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
Cupertino, California 95014
Phone (408) 253J071
CONNECTION PERMIT
R.O.S./P.M./TractNo. R-79-7 Lot No. 4,04-
A.P.N.: Book 3 Ro Page 0) Parcel Date Jun e- 5 1/9
Property Owner: )W Ve )42P&S
Mailing Address: ;Iire�ly6 mLOL3-/e04-PeL/ I
(If different) c-�5 --ve OJa ryle-n-f 40
OX 6/7/
Telephone: i
a g.5-
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application,fgr connection of the property at:
-4100 V1 C? Pav/ :5,-) l;4 JAL )
X0
consisting of the following TYPE OF BUILDING(S):-,# 21 —42.
Residential: Single Family No. Units :00
—; Multiple Family
_; 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 V4
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 6 4!� of 9��' .o g-4 Building Department and obtain
inspection and approval by said Building Departmerft prior to covering off the work or use of the sewer.
4. To first expose and inspect for serviceability the Lateral Sewer (that portib'n of the sewer within the street right-of-way or
easement), prior to starting construction of the House Sewer.
5. That thi4 permit doel,not conAtitute a request'for the issuance of an encroachment permit for sewer,construction-in the
street/public right-of4ay of the agency havA*jur dir4joh thereover.+ p J,
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): -F#Y5 1".4 L- KOA)A)G-6 MR)
dtAA,; C( 40LA4 e'e !a 57a-tof 1 �dY"wf 5
EA BACKFLOW Protective Device shall be installed on the above property by the owner. Type of device and installation
Ishall comply with the Plumbing Code Requirements of the jurisdiction shown in 3 above.
FEES:
Connection Permit Fee: $
Sewer Service charges to June 30, 119�,$ J--q"90 /MO.X A0 MO.:
Inspection Fee for backfipw prote tlon device, - ("(3-tA
e-- ,, ed t�
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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: Z"
Owner's Agent: zee Coo
iprTnt t�
e,
Receipt of$ 76tq—acknowledged and permit granted.
MARK TH S& CO., INC. District Manager-Engineer
Note:See Details on other side of this permit.
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
c not to exceed five(5) feet.
J
v Removable Cleanout Plug
0.
0
li Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
1/B Bend
Adaptor coupling
Lateral Sewer House Sewer
Lateral Sewer elope House Sewer slope
determined by District determined by building department
—CLEANOUT TO BE SAME SIZE AS LATERAL SEWER—
Notes:
1. Distance from the property line not to exceed five (5')feet.
2. Property Line Cleanout, Lateral Sewer Cleanout,to be same size as Lateral.
3. The maintenance of the Lateral Sewer Claanout is the responsibility of the Property Owner.
4. House sewer minimum slope determined by local Building Department plumbing code requirements of the
agency having jurisdiction thereover.
TYPICAL BACKFLOW PROTECTIVE
DEVICE INSTALLATION
TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS
INSTALLATION Jurisdictional Restrictions
Accepted By All Jurisdictions
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Installed Beluw Grade installed Above Grade
Shown Between Street Right-iii and Building Shown At Property L,ne Clsonaut Shown AdlOasal To Building
Requires Regular Malnlenance vi Requires Minimum hwTh enonce Requires Minimum Maintenance
Valve To Be Removable Valve should Be Removable
VALVE ACCESS BOX FINISH FLOOR
rc with/VentedCover
w
0 FIN19H eLggF KELLY VALVE
!IKIELLYVALVE.LVE ACCESB BOX AIN Finish GradeFinish Grade 3
m
BACKWATER
VALVE
we—FLOW O FLOW af' FLOW
Notes:
t. The Backflow protective device to be located on site in the house sewer.
2. The type, location and installation of the Backflow Protective Device shall comply with the local Building
Department plumbing code requirements of the agency having jurisdiction thereover.
3. Device to be accessible and maintained by the Property Owner.
4. If a Kelly Valve is installed at Property Line, it is to be readily removable for Lateral Sewer Maintenance.