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PERMIT P-15683
s 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. 'R ► 7 Lot No, / /
A.P.N.: Book�_Page 0 t Parcel 0 1 p Date
Property Owner: 6-1 11'1 6lei /C S /
Mailing Address: /d G ?5' (� M Pa 01&-W r(r–
(If different) Rpt 6A G Zl3„3
Telephone: 7—�'
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
/D / //IACA7JU///J LAit/6 �Z?xzO
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family Multiple Family ; No. Units
Commerciall; 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 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). �f ,
3. To acquire a Plumbing Permit from the _ tJ--� of , Building Department and obtain
inspection and approval by said Building Department prior 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 lHouse Sewer.
5. That this permit does not constitute a request for the issuah60of anencroachment permit for sewer construction in the
street/public right-of-way of the agency having jurisdiction thereover.
t
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):
MA 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: o $ 7 �
1�
Sewer Service charges to June 30, 19 ,, $ J V-9 fmo. x o mo.: $ 7� 00
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.
v
Acknowledgment:
Owner's Agent: V C e:�?A-,'
(print name)
Receipt of$ z 2 �' 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
T
w Removable Cleanout Plug
u
0
a Finish Grade
Wye for Riser
Sewer Cleanout Boz with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling /8 Bend
�_- - FL�
I oteral Sewer I House Sewer
Lateral Sewer slope House Sewer slope
determined by District 41 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 Properly Owner,
4. House sewer minimum slope determined by local Building Department plumbing code requirements of the
agency having jurisdiction thereover.
a
TYPICAL BACKFLOW PROTECTIVE
DEVICE INSTALLATION
TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS
INSTALLATION duriedietional Restrictions
A...ales By All Juri sdicliona
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Installed Below Grade Installed Above Grade
Shown Between Street Right-of-Way and Building Sbonn At Powers Line Cleanout Shown Adjacent To Building
Requires Regular Maintenance x Requires Minimum Mainle .r,,. Requires Minimum Maintenance
Valve To Be Removable Valve Should Be Removable
> VALVE ACCESS BOX FINISH FLOOR
f
KELLY VALVE
VALVE ACCESS BO% AiqE
Finish Grade
Finish Grade E
BACKWATER n
VALVE
FLOW Al FLOW ET FLOW Al
Notes:
1. The Backflow protective device to be located on site in the house sewer.
2. The type, location and installation of the Backflow Prolective 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.