P-15667 ' Y"Ma 1 Y•,�-.ri -rfr � r'n �T^4�-"Ir�rn uY . I•�--.. ..T�,f\r• _
;-,,PERMIT M5667
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 f
R.O.S./P.M./TractNo. 8797 Lot No. 9 (/ �,
A.P.N.: Book t'o CPage0 / 1 Parcel �7— 7 Date I U tie
Property Owner: P. �J.5 e &ytJ ems_,_ V J
Mailing Address: G r O v7 7td PS [ i�dJ
(If different) p�
Telephone:
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
V/a A 64 P-4- A y70
consisting of the fallowing TYPE OF BUILDING(S):
Residential: Single Family ; Multiple Family ; No. Units
Commercial_x__; Industrial ; Other ; No. Units FDO L-
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 4J0gewP r'n0 Building Department and obtain
inspection'and approval by said.Building Department rior to covering of 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 sheet 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 jurisdiction thereover.
6. To call Underground Service Alert(USA) 11--8800.227-2600, at least 48 hours prior to starting grading or digging operations.
SPECIAL PERMIT CONDITIONS(Exhibits): Poo/ Gp 0 moe &If s
0—AA- to r ga 4
❑ A BACKFLOW Protective Device shall be installed on the above property by the owner. Type of device and installation
shallcorn Iy with the Plumbing Code Requirements of the jurisdiction shown in 3 above.
FEES: trD RV/—S ,- 0`0 L- eONA1E"e77,e ) r/ �O y Qelevxzce�-
_�Ja7 SQA� A� ,B,GI�Gi 9
Connection Permit Fee: $
Sewer Service charges to June 30, 19 ,$ r g /mo.x—Jo_ o.:/ $
Inspection Fee for backflow protection device: V<765 / tJ � �*" �� $
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: fP� [�DDOP��
(pri name)
Receipt of$I acknowledged and permit granted.
MARK THO &.CO., INC., District Manager- ngineer
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,
du not to exceed five(5) feet.
J
u
Removable Cleanout Plug
6
a
Q. 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
FLOW m
LolerOl Sewer House Sewer
Lateral Sewer slope House Sewer slope
determined by District determined by building de parlment
—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 Jurudialanal Rutrictlone
AAUPled By All Jurisdicuone
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Installed Below Grade Installed Above Grade
Shown Between Street Right-obwoy and Bulldin9 Shown At Property Line Cleanout Shawn Adjacent To Building
Requires Regular Maintenance i Requires Minimum Maintenonce Requires Minimum Maintenance
Valve To Be Removable VAN. Should Be Removable
> VALVE ACCESS BOX FINISH FLOOR
¢ IVented Cover
p vI F H FLOOR KELLY VALVE
a
A '!TKELLYVALVE
J
LVE ACCESS Box d y'
Fmlah Grade
Finish Grade
3
BACKWVALV
FLOW p FLOW 31• F OS w g
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.