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PERMIT P-15660
�"CUPERTINO SANITARY DISTRICT"
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
Cupertino, California 95014
.Phone (408)'253-7071 "' ''��'•,gX ;.
CONNECTION PERMIT
R.O.S./P.M./Tract No. � Lot No.
A.P.N.: Book3 7�O Page Parcel / 2 Date V(l pie 519910
Property Owner: )t{ 15 5 VVe-Y7 P&5
Mailing Address:G��D /
(If different) -
Telephone: A �
y8T-eg;
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
20,51// Vl,* )visa 141.
consisting of the following TYPE OF BUILDING(S): 8 X/-2
Residential: Single Family ; Multiple Family No. Units 90
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 � of 8P.lV'�f , Building Department and obtain
inspection and approval by said Building Departm nt prior to covering 15f 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 dot3s��s,,not constitute a request (or the issuance of an encroachment permit for sewer, construction-in the
street/public right-of-way of the agency havine,�"ju%dictioh fhereovert,) J 4 ( ,
6. To call Underground Service Alert(USA) 1-800-227.2600,at least 48 hours prior to starting grading or digging operations.
SPECIAL PER CONDITIONS(Exhibits): /v 0 e-i4 L 6AWX-1-1-7e�(
❑ 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: $_�
Sewer Service charges to June 30, 191( ,$ 3�b0_/mo.x ® mo.: $ �
Inspection Fee for backflow grotectloq device: �49O)r /' / n1&Td $
5 kv C�
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:
Owner's Agent:
(p int name)
Receipt of$ 26e acknowledged and permit granted.
MARK THO S&CO., INC., District Manager-Engineer
by
Note:See Details on other side of this permit.
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
ar not to exceed five(5') feet.
e
J
a Removable Cleanout Plug
n
0
o. Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
1/8 Bend
Adaptor coupling
- �FLDW m'
Lateral Sewer House Sewer ---r-►
Laterpl sewer slope House Sewer elope
determined by District laddetermined 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 Cleanout 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 Rutricuon
Acupted By All Juri.d,on.ds
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grad. Installed Below Grade Installed Above Grade
Shown Between Strut Right-at-way and Building Shown b Prophets Line Cleanout shown Adjacent To soloing
Require. Regular Maint.n.nog i Require,Minimum MdWennce Require,Minimum Maintenance
Valve To Be Removable Volvo Should Be Removable
VALVE ACCESS BOX
H FINISH FLOOR
tt with/Vented Canr
w
o tKELLY
�gEILY VALVE
A VALVE ACCESS BOX EFinish GradeFinish Grade
n
BACKWATER
VALVE
FLOW 8 GLOW 1)' i FLOW K
Notes:
1. 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.