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,l 1( PERMIT M5669
s dUPERTINO SANITARY DISTRICT"." `
Santa Clara County
2.0, 065 Stevens Creek Blvd., Bldg C, Fax (408)253-5173
I - Cupertino, California.95014 - +.•,
-
Phone (40B)-253-7071 •�+-r" � - ,,( `"3.
i y CONNECTION PERMIT
7S
R.O.S./P.M./Tract No. 6$ L� Lot No.
A.P.N.:.Book 3/( Page�LParcel /2� Date Cl q C / /
i
Property Owner: _(r/zt 1-/OYI 4&p"PS !g A )4V�
' Mailing Address: _ / /7
(If different)
Telephone:
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
/ 49DK !//a So �-erf {i?, local rpinU
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family_9 ; Multiple Family ; No. Units
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 gradeland
accessible) located at the point of connection with the Lateral Sewer (that portion of the sewer in the street right=df=way or. . w
District Easement).
3. To acquire a Plumbing Permit from the of Building Department and obtain
inspection and approval by said Building Department Orior 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 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-vypy of the lagency heving,jurisdiction thereover.
' 6. To call Underground Service Alert(USA) 1-8001227-2600, at Ieast,48ihours prior-to starting grading..or,:digginig operations.'."
SPECIAL PERMIT CONDITIONS(Exhibits):
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:
97 g $
Connection Permit Fee:
Sewer Service charges to June 30, 190„$ /mo.x =mo.: $ Ci7Y
Inspection Fop for backflow prote tion device: $ G 2 , '
17>v Ic4-Pd It+
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:
f9m Owner's Agent: 'Zoe . 1500 oe_/t,-
2 (print n me)
Receipt of$ acknowledged and permit granted.
MARK TH S CO., IN ., District Man go -Engineer
by
Note:See Details on other side of this permit.
TYPICAL CLEANOUT FOR LATERAL SEWER
Distdnce from Property Line
to be as close as phacticable,
,es not to exceed five(5) feet.
- c
Removable Cleanout,"Plug
or
a I
O j
Finish GrOde " '
Wye for Riser Sewer. Cleanout Boz with 'LId to be accessible
-and Incintained by with
owner.
Short length Riser Pipe
1/8 Bend
Adaptor coupling
Lateral Sewer House Sewer
Lateral Saw ar elope House Sewer elope
determined by District determined by building deportment
— 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 Jurudladlen.d Re.Iriction.
A....led Br All Jursdio,.a.
FIGURE I FIGURE 2 FIGURE 3
Installed slid.Grad. Installed Belo.Grad. Installed Above Grad.
Shown Between SIru1 Right-al-Way and Bulldlna Shown At Praa.rt,Line Cleanout shown Adloc.m To Build-mit
Requir.s Regular Now...nee w Requires Minimum Maintenance Red,... Minimum Malnlenonce
Valve ID Be Removable Valve Should Be Removable
H VALVE ACCESS BOX FINISH FLOOR
¢ .Ith/V led cover
n
� vM �tKELLY
��W KELLY VALVE
A.VALVE A.....60% EFini.h Grad.Finish Grade
BACKWATER
VALVE
F OLS W _Pl t FLOW FLOW J1'
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.