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.PERMIT P-15666
'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. s79-7 Lot No. !_ G 3v r ld!tnc ) / M&
A.P.N.: Book_Page Parcel 1 -2- 2 Date V o r) - J� t
Property Owner: S5 . C.tl
Mailing Address: L t Q Blit
(if different) p� �S r
Telephone: S�AC let-Vg'l GrQ 9✓��
CJ $S�lv000
Sirs: '
(]/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
V1 ct_ Ra v', S o PAY n D
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family Multiple Family ; No. Units n
Commercial_; Industrial ; Other ; No. Units Per-f'ea
do hereby request a permit to connect to the sewer system of the Cupertino Sanitary District.,
IN CONSIDERATION OF THE GRANTING OF THIS PERMIT, THE OWNER AGREES:
1. To comply with all existing Ordinances, Rules and Regulations of the Cupertino Sanitary District as now or hereafter amended.
2. To maintain the House Sewer(that portion of the sewer within private property) which includes a cleanout (raised to grade and
accessible) located at the point of connection with the Lateral Sewer (that portion of the sewer in the street right-of-way or
District Easement).
3. To acquire a Plumbing Permit from the 6r of Building Department and obtain
inspection and approval by said Building Department p or to covering of 1he work or use of the sewer.
4. To first expose and inspect for serviceability the Lateral Sewer (that portion of the sewer within the street;right-of-way or
easement), prior to starting construction of the House Sewer.
5. That this permit does not constitute a request for the issuance of an encroachment permit for sewer,construction'in the
street/public right-of-way of the agency having.juri$vdiction thereover_, _
6. To call Underground Service Alert(USA) 1-80,0-1227.2600, at least 48 hours prior to starting grading or digging operations.
SPECIAL PE=MIT (Exhibits): it N 5 / 4-t
P Q GC-9,W AXA4 G r C �cJUA S A g
❑ 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: $ e�
Sewer Service charges to June 30, 19 ,$moi"' /mo.x_ mo.: $
Inspection Fee for backflow protection device: C 4-c� 6.0 d 4- $
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: + tG
Owner's Agent: .L ne 2 646) &dL
(pri t name) i
Receipt of 7760-&ecknowiedged and permit granted.
MARK TH & O., INC., District Manager-Engineer
by
Note:See Details on other side o/this permit. '
x
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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
n
0
a Finish Grade
W�.
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
—FLOW or
Lateral Sewer House Sewer
Lateral Sewer slope 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 Sower 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 Junadlalional R..W.lane
Accepted By All Juriediclians
FIGURE I FIGURE 2 FIGURE 3
Installed eelme Grade Installed Belo„Grade Installed Above Grade
Shorn Belson Street Right-0-Way aria Bulldina Shoran At Property Lme Cleanout Gnash Adlocegt To Bullamg
Requires Regular MaintenanceZ Regwr•e Minimum Maintenance Regmrae Minimum Maintenance
Valve To Be Removable Valve Should Be Removable
D
* VALVE ACCESS BOX FINISH FLOOR
,rlln Nenbe cover
s
a FIN ISN FLOOR LLY VALVE
c 2 \
A inwhGrade
rvs
al
VALVE ACCESS BOX KELLY VALVE
Fmuh Grad•
q'.
Finian trade
5 `
i
m
BACKWATER
VALVE
FLOW FLOW 3I FLOW A
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.