15205 �3
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SERIAL P Mgr, 15 2 0 5
SEWER CONNECTION PERMIT NO.
OCUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No...F,/M... Lot No.. .........
20065 Stevens Creek Blvd. A.P.N. Bk.. .`` ... Pg.....J.7.. Par............
Building C
Cupertino, California 95014
Ph 4 2 -771 .. eNvtYJE✓ 7Z 9
Phone O6) 53 0 Date...J.�!...................................... 19......
The undersigned,being the owner(or owner's agent) of the property located at ........................................................
..� 7
....+>1......... OI v. ..!..u..../f.(��.n r/P )... e,-0,4,a4170- . .. . .........................................
consisting of the following TYPE OF BUIILDING:
Residential: Single family....X..... Multiple............ No. Units...........
Commercial............ Industrial............ Other............ No. Units............
does hereby request a permit to connect to the sewer system of the Cupertino Sanitary District.
In consideration of the granting of this permit,the undersigned agrees:
1) To comply with all existing regulations and Ordinances of Cupertino Sanitary District and all future regulations and
Ordinances which may be adopted.
2) To maintain the house sewer(that portion of the sewer within private property)and to provide access to the lateral sewer through
a cleanout raised to grade at the property line or at the limits of any xisting District easement. (Note—Detail J)
,.,• 3) To acquire a permit from the ..�!�....3.V....�<��'�.�n................................. Building Depart-
ment 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 prior to starting construction of the house sewer.
—y/ r
Property Owner's Name.T��.�...,...r-ort.)YI...(..B?!t.5 /Telephone....52.!9.4-, r..`?..7 ...z
Mailing address if
differentfrom above...................:..............................................................................................
By... .. ��...............
/J❑f/ A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above
� property. (Note—See,Detail I)
FEES: _
'L O5
Connection Permit Fee $......i.. .....
�f rr
Sewer Service charges to June 30, 199?., �...../mo. x.....l.mo.
Inspection Fee for backflow protection device
/ ✓/ TOTAL $
•teceipt of ........ acknowledged and permit granted. MARK THOMAS&CO. INC., District Manager-Engineer
NOTE: / �
I�rO physical connection of the house sewer By"""""""' """""""""""""""""""'
to the lateral sewer shall be made until writ_
ten permission is received from the District. I rOTE. See Details on other side of this permit
CUPERT/NO SANITARY DISTRICT -
NOTES: all valves to be accessible and maintained by Property Owner.
Overflow point at least twelve inches 02"1 below lowest finished
floor containing plumbing.
Kelly Valva installed at Property Line to be readily removable
for Lateral Sewer maintenance.
J
e
Finishe Floor Level
n ^' Kelly Valve Finish Floor Level 43
—.E Finish 1),Ir LL
Kelly Valve
1 @
Valve Acca ss 8�pp�aax —/ AA E in E m
with Vented Cyver p Volae Access Box --
`.If', Backwater Valve
Figure I Figure 2 Figure 3
Kelly Volvo- Below Surface Backwater Valve—Normally Kelly Valve-Above Ground
Inetallclion-Shown al required installed at shallowest point Instoll [ion-Shown Installed
Property Line Cleouout. along House Sewer between close to building. •
Property Line and building.
DETAIL
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I
Distance from 11 to be as
close as practicable.
Removable Cleanout Plug
o. Finish Grade
Wye for Riser vn'
Sewer Cleanoul Box•with Lid to be accessible
and maintained by properly owner.
Shur! length Riser Pipe
Adaptor coupling 1/8 Bend
_ FLOW m
Lolaral Sewer Home Sewer
M Id�OT E' minimum slope determined by Building Deportment.
elk+ Lateral Sewer Cleanout to be some
size as Lateral Sewer •
DETAIL
STANDARD CLEANOUT FOR LATERAL SEWER J