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{ PERMIT P-15673
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'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. r8/ Lot No. I p /
A.P.N.: Book 3(0/te7 Page d I Parcel � ) O Date V cJ /4 3 I X19
Property Owner: ��P "TrA 9L. GLR-5//S SLS LP
Mailing Address: /�In E, .(`�Q CYOctJ Zoe.
(If different) ncc le 0.. /V '<l3Gi3
Telephone:
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
16 / y2; MIA e-,9 Dyi✓l 4AAJ6- P6-977,uo
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 sys£em of the Cupertino Sanitary District.
IN CONSIDERATION OF THE GRANTING,OF THIS PERMIT,THE OWNER AGREES:
1. To comply with all existing Ordinances,�`,/Mules 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 poin`t)of connedtion with the Lateral Sewer (that portion of the sewer in the street right-of-way or
District Easement). I
3. To acquire a Plumbing Permit firom the of C, yLU 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 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-way of the agency having jurisdiction thereover.
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):
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:
00
Connection Permit Fee: $ 11 ,
Sewer Service charges to June 30, 1912,$ / 19 !!::/mo. x 8 mo.: $ 44 eg
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: z9E11(f
(print name)
Receipt of$ �Z 20, acknowledged and permit granted.
MARK THOMAS& CO., INC., District Manager-Engineer
by ®- —
t
Note:See Details on other side of this permit.
TYPICAL CLEANOUT FOR LATERAL SEWER
He I Distance from Property Line
to be as close as practicable,
0o not to exceed five(5) feet.
c
J
`. Removable Cleanout Plug
n
0
o. 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
Lateral Sewer House Sewer
Lateral Sewer slope House Sewer slope
determined by District 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 duriseictionm Restria,ians
Accepted By All Juriediabans
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Installed Bel.,Grade Installed Above Grade
Shown Between Street Nlght-of-Woy and Building Shown At Property Line Cleanoul Shawn Adjacenl To Building
Requires Regular Maintenance ou Requires Minimum Maintenance Requires Minimum Maintenance
Volvo To Be Removable Valve Should Be Removable
VALVE ACCESS BOX FINISH FLOOR
do 7wIlh1V led color
ou
p Level of FINISH FLOOR KELLY VALVE
ba
a.IKELLY
inish Grade
VALVE ACCESS BO% VALVEFinish GradeFinish Grade
E
m
9ALNWATEfl
VALVE
FLOW J? FLOW D/ 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 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.