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'`PERMIT P-15661
CUPERTINO SANITARY DISTRICT° '
Santa Clara County . .
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
. _ Cupertino, California 95014
Phone (408) 253-7071.
CONNECTION PERMIT
R.O.S./P.M./Tract No. 879'7 Lot No. _1,3
/ OO/
A.P.N.: Book_3 f0 Page Parcel (ZZ Vane
ane
Property Owner: T'S rJ' Uen Y e5 '
r byf N� N Q
Mailing Address:
(If different) I /
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Telephone: k
J£SS- Gooa
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
2 O//Z D ✓� /s C—1/ — /.el
consisting of the following TYPE OF BUILDING(S): , 4(C-2/ —a
C- 3/ - S $
Residential: Single Family Multiple Family X; No. Units 20
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.
�1 -
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 �r _, Building Department and obtain
inspection and approval by said Building Department prior to covering of he 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,thisl:permit doet not constitute a request for the issuance of an encroachment permit for sewer,construction-in the
street/public right-of-why of the agency liavi4jur' diction thereover
I �fl , ,� i Y. 'ary � , F,t (y9
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):
u
❑ 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: $60
7l
Sewer Service charges to June 30, 19
Inspection Fee for backflow pr taction device: $
. ** Largs-O'uCP0.5t Gv-e.d44
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: 1edg- 40d4 &01 ,
(print ame)
Receipt of$ /(O acknowledged and permit granted.
MARK THOMAS& 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,
A, not to exceed five(5) feet.
c
J
T
u
Removable Cleanout Plug
a
0
0- Finish Grade
ev
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
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 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 Jurneieuonpl Ruvimion•
Acnspted By All Jurisdictions
FIGURE I FIGURE 2 FIGURE 3
In.lalted Below orad. Installed Below Grade Installed Above Grade
Shown Bet....Str..I R1,11rl-0-W.y and Bohol, Shown At Properly Line Cleanoul Shown Adid...t To Building
Requires- Regular Maintenance W Require.Minimum Moinbnanc. Reauire. Mimmum Moinl.nance
Vole.To Be Remavo Dls VoW. Should Be Remavabl.
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VALVE ACCESS BOX FINISH FLOOR
rc wlth/V.nt.d Corer
iii�� KELLY VALVE
o' d
mim Grad.
r�
VALVE ACCESS BOX KELLY VALVE
AS
f
Finish Grade
Finish Grade
F c `
m �
� m
BACKWATER
VALVE
� W FLGW dl FLOW sl
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.