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P-15664 (2) -"_PERMIT vP-15664 CUPERTINO SANITARY DISTRICT"'' Santa Clara County 20065 Stevens Creek Blvd., Bldg C, Fax(408) 253-5173 Cupertino, California 95014 ^ k Phone (408) 253-7071 CONNECTION PERMIT R.O.S./P.M./Tract No.-IFLM 7 Lot No. 4' / G A.P.N.: Book_3/ _Page 0I Parcel / 2 Z Date Property Owner: `JS Vt µ44JY'P Mailing Address: G O-Al HcPS (If different) Telephone: Sirs: (I/We), being the owner(s) (owner's agent), hereby make application for connction of the propert at: 2,243,Tis f�v�5o���� L" ) consisting of the following TYPE OF BUILDING(S): Residential: Single Family ; Multiple Family�K_; No. Units �?D 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 / of 0)4f 2 4-tt.� A , Building Department and obtain inspection and approval by said•Building Department grrior 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 sewei„construction in the e street/public right-of-4ay of the agency,havin jur”diction 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): _It 100 ^^'044 S/fjQ L ek,C/95­C-77&AJ �r TRAACLAAG Q C GP.1'J C2.._ �1 '5,0- 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. d FEES: Connection Permit Fee: 01V $ sto Sewer Service charges to June 30, 19%—, $540 /mo. x 4m 04: $to Inspection Fee for backflow protection device: -r'-66*t-44V c4d.zoir 60 $ l a>7&&4 414, 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 n me) Receipt of$ acknowledged and permit granted. MARK THOM S& CO., INC., District Manager-Engineer b ' Note:See Details on other side of this permit. �' TYPICAL CLEANOUT FOR LATERAL SEWER Distance from Property Line to be as close as practicable, c not to exceed five(5) feet. J T Removable Cleanout Plug la 0 CIL Grade Wye for Riser Sewer Cleanout Box with Lid to be accessible and maintained by property owner. Short length Riser Pipe 1/B Bend Adaptor coupling 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 Jurisdictional Rovlmlane Acaspbd By All Jari.dicHon. FIGURE I FIGURE 2 FIGURE 3 Installed Below Grade Installed BelGvs Grade Installed Above Grade Shawn Between Stnet RIGM-o4Woy and BuilElnp Shawn At Property Line Cleanout Shown Adlabent To Building Requires Regular Maintenance w Rogaine Miaimum Malmenante fleamree Minimum MalnM1npnCe t Valve To Be Removable Volvo eaould Be Removable J > VALVE ACCESS BOX FINISH FLOOR ¢ wHN Venbd Cover W a v FINI FLOON KELLY VALVE a'!TKELLYVALVE ' VALVE ACCESS BOX d g. Finish Grade Finish Grade S n BACKWATER VALVE FEW p FLOW sl Flow 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.