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PERMIT P-9.5663
''CUPERTINO SANITARY DISTRICT-
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408)253-5173
Cupertino, California 95014 as:.
Phone(408) 253-7071 -
CONNECTION PERMIT
R.O.S./P.M./Tract No. Lot No.
A.P.N.: Book I b Page-PJ Parcel I Z Z- Date
Property Owner: �.5.? y/P—-17 A) Y lop
Mailing Address:
(If different)
Telephone: G��o[I¢ jSdSa
y foo
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the prop
gny at:
20�3D
consisting of the following TYPE OF BUILDING(S):
Z31- 3 8 20
Residential: Single Family ; Multiple Family_X ; 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.
. •pv�.,
2. To maintain the House Sewer (that portion of the sewer within private property) which includes a cleanout (raised to grade and 1
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 � of �� Building Department and obtain
inspection and approval by said,Building Departmen 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 thiwermit doe not constitute a request for the issuance of an encroachment permit for sewer,construction"-In the
street/public right-of-°4ay of the agencyhavinr juri�dictjloi thereoveo.�
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 O ,5/e- L e! drWGL 77SW ri
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: $ 71�0
Sewer Service charges to June 30, 19-!�/,,$ —Imo. x /A7LMo.: $
Inspection Fee for backflow protection device:-'J'- 0 p-V` �u�CA*-a �!'W4 $
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:
_--L L4ti/
Owner's Agent: 00,oza
(print arae)
Receipt of$ acknowledged and permit granted.
MARK THO S & CO., INC., District Manager-Engineer
by
Note:See Details on other'side of this permit.:
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
N not to exceed five(5) feet.
J
m Removable Cleanout Plug
n
0
o. Finish Grade
Wye for Riser Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling /8 Bend
—FLOW or
Lateral Sewer House Sewer
Lateral Sewer slope Mouse Sewer elope
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 Jurndimm�al Roviniane
AacePbd BY All Jurladicbon.
FIGURE I FIGURE 2 FIGURE 3
Installed Bao.Grade Installed Belo.Grad. Installed Above Grad.
Shawn set...n Strut R,gM-ar-Way and Buildlne Shown Al Property Line Cleanout Shawn Adjacent To Building
Regwos Regular Malnoto-o- i Requires Minimum Maintenance Requves Minimum M.Inotuince
Volvo To Be Removable Valve Should Be Removable
> VALVE ACCESS BOX FINISH FLOOR
e .ItN Vented Cover
w
a � � KELLY VALVE
A.
^_�Z inion orad•
VALVE ACCESS BOX KELLY VALVE )+
Finish Grade
rFlomsh Grade
•r, S
m
BACKWATER
VALVE
Few a/ FLOW AI FLOW P
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.