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j PERMIT P-i5691
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.fTract No. R S ! 7 Lot No. /
A.P.N.: Book�L Page D / Parcel Q / Date !1=
r
Property Owner: qty 6(e' .5 L�
Mailing Address: Z® 6A �
(If different) ;c �cAe ff`,0/l CA
Telephone:
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family y , 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 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 6tAt of (!�;J Pf L4 Building Department and obtain
inspection and approval by said Building Department prior to covering 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 issuande of an.encroachment permit for sewer construction in the
street/public right-of-way of the agency having jurisdiction thereo er, ( -
6. To call Underground Service Alert(USA) 1-800-227-2600, at least 48 hours prior to starting grading or digging operations.
r!_
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:
Connection Permit Fee: $ 1/1
Sewer Service charges to June 30, 191, sJ ov /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.
Acknowledgment:
Owner's Agent: yG V
�i (print name)
5V
Receipt of$ G Z �• acknowledged and permit granted.
MARK THOMAS&CO., INC., District Manager-Engineer
Note:See Details on other side of this permit.
IX
TYPICAL CLEANOUT FOR LATERAL SEWER
19 Distance from Property Line
to be as close as practicable,
at not to exceed five(5) feet.
J
T
a, Removable Cleanout Plug
n
0
a Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length /B Bend Riser Pipe
Adaptor coupling
�- 4FLDW
Lateral SewerHouse Sewer
Lateral Sewer slopeI. House Sewer slope
determined by District erl 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 Burieaimlgnal Reaarorane
Aace Pted By All Jurisdiction,
FIGURE I FIGURE 2 FIGURE 3
Installed Bela.Grade Installed Below Grade Installed Above Grade
Shen Between Street Right-ot-Way and Building Shown At Protons Une Cleanout Shawn Adjacent To Building
Requires Regular Mainbnonce i Requires Minimum Maintenance Requires Minimum Mvimenance
Valve To Be Removable Valve Shoald Be Removoble
* VALVE ACCESS BOX
FINISH FLOOR
.nn/vantea cover
o Level of FINISH FLOOR KELLY VALVE
be
trKELLY
VALVE ACCESS BO% EFinisn GradeFlnisn Grade
i
BACKWATER n
VALVE
FLOW Dl FLOW l? FLOW i?
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.