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PERMIT P-15689
CUPERTINO SANITARY DISTRICT'
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
Cupertino, California 95014
Phone (408) 253-7071
pp � � --�� CO'N�N/ECTION PERMIT
R.O.S./P.M./Tract No.� Lot No. � J, /,A.P.N.: Book Page Parcel Q 19
Date
15 ,
SlProperty Owner: 5:
Mailing Address:*4e; I
E /IPn Cr 1_
(If different) Pn,/O .441k C,4 r7�13G 3
Telephone:
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
40 �IWE-, e2,719,Q?77.4J0
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family Y , Multiple Family ; No. Units
Commerciall; Industriall; 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). 1 //
3. To acquire a Plumbing Permit from the of GtJ eAJ Building Department and obtain
inspection and approval by said Building Department rior to covering of the work or use of the sewer.
4
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 theNHouse 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. f
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):
1EA 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: $—. �
' C S 00
Sewer Service charges to June 30, 19-11, $�pp /mo. x mo.: $
Inspection Fee for backflow protection device: $
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. J
Acknowledgment:
Owner's Agent: y� yC0/1/
(print name)
Receipt of$ 30
Z? �r acknowledged and permit granted.
MARK THOMAS &CO., INC., District Manager-Engineer
Note:See Details on other side of this permit.
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
°i not to exceed five(5) feet.
C
J
w Removable Cleanout Plug
n
0
CL Finish Grade
Wye for Riser
Sewer Cleanout Boz with lid to be accessible
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling 1/8 Bend
�- FLOW m
Lateral Sewer House Sewer
Lateral Sewer slope House Sewer slope
determined by District g�l 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 Jurisdictional Restrimions
Accepted By All JurisdicNone
FIGURE I FIGURE 2 FIGURE 3
nslalbd Below Grade Installed Below Grade Installed Above Grade
Shown Between Street Right-ot-Way and Building Shown Al Pmperry Line Cleanoul Shown Adjacent To Building
Requires Regular Mainlenance uiRequires Minimum Mainlenance Requires Minimum Mainlenance
— Valve To Be Removable Valve Should Be Removable
t VALVE ACCESS BOX FINISH FLOOR
rcwith/Vented Cgwr
Lu
A.
Level of FINISH FLOORso KELLY VALVE
a. IKELLY
VALVE ACCESS BOX E
Finian Grade Finish Grade �L
F ; •
n Z
BACKWATER m
VALVE
f LOWyl FLOW l.T FLOW n/
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.