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PERMIT P-15693
" CUPERTINO SANITARY DISTRICT
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
Cupertino, California 95014
Phone (408) 253-7071
AS CONNECTION PERMIT
R.O.S./P.M.fTract No._Q Q1 -7 Lot No. 2�/ / / pG
A.P.N.: Book0 ,�r Qp_ & ` Page Parcel . _ Date �1 t) (c.... 3 / /
Property Owner: W C v ) 66f.`SrC5
Mailing Address: � cb X0eq6r-
(If different) ApL - e
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_ 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). 1
-01/
3. To acquire a Plumbing Permit from the c of C-aJ t , Building Department and obtain
inspection and approval by said Building Department pri r to covering of the work or use of the sewer.
4. To first expose and inspect for serviceability the Lateral Skewer (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 requast for the issuande of anaencroachment 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.
SPECIAL PERMIT CONDITIONS(Exhibits): t
® 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: rye p O
Connection Permit Fee: $�(�=
`,7/
Sewer Service charges to June 30, 19 J-7, e
,$ �-C� /mo.x 4_mo.: $ eo�
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:
(print name)
Receipt of$ 22�• acknowledged and permit granted.
MARK THOMAS& CO., INC., District Manager-Engineer
b �
Note:See Details on other side of this permit.
f)
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
not to exceed five(5') feet.
J
Removable Cleanout Plug
0
0
L�8
Finish GradeWye for RiserSewer Cleanout Box with Lid to be accessihle
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling1/ Bend
Lateral SewerSewer
Lateral Sewer slope House Sewer slope
determined by District 80 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 Jurisdic Y onol Rietriaeione
Accepted By All Jurisdictions
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Installed Below Grade Installed Above Grade
Shown Bot aeen Street RipN-of-Way and Building Shown At property Line Cleanout Shown Adjacent To Building
Requires Regular Maintenance Requires Minimum MoiNenince Requires Minimum Maintenance
Valve To Be Removable Valve Should Be Removable
VALVE ACCESS BOX FINISH FLOOR
wnNv.med Cover
o Level of FINISH FLOOR KELLY VALVE
AJOKELLY
rish Grade
VALVE ACCESS BOX VALVEFinish GradeFinish Grade41
Z
BACKWATER m
VALVE
FLOW lJl FLOW IDl FLOW a/
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.