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SERIAL
SEWER CONNECTION PERMIT NO. P r 15204
�CUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No. / ..... Lot No.5..........
20065 Stevens Creek Blvd. A.P.N. Bk..,�7...... Pg....1.7.... Par............
Building C
Cupertino, California 95014 / n
Phone (408) 253-7071 Date ....2.Z.....
The undersigned, being the owner(or owner's agent)of the property located at ........................................................
.........?7(n.i.............'.:'......../.ra^e-.;I...........�k��.Y'�``. .....................................................
consisting of the following TYPE OF BUILDING:
Residential: Single family....;.... Multiple............ No. Units......I...
...
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)
46 3) To acquire a permit from the ..(c..... �.�1....G J t!1V... ....1•........................... Building Depart-
ment and obtain inspection and approvaby said Building department prior to covering of the work or use of the sewer.
4) To first exposeandinspect for serviceability the lateral sewer prior to starting construction of the house sewer.
Property Owner's Name..{.r .Y' `'.i. Telephone.....
Mailing address if
differentfrom above...................................................................s.......... ....................................
By...../„?,7.4/�. ..................
FqA standard backflow protective device shall be installed, to the satisfaction of the Budding Department, for the above
property. (Note—See Detain)
FEES: t G
Connection Permit Fee $... .(`�..�...
Sewer Service charges to June 30, 19 $...../n.” .../mo. X......mo. .........�� �.
Inspection Fee for backflow protection device l
/ TOTAL $
',Seceipt of$.G.:.?........ acknowledged and permit granted. MARK THOMAS&CO. INC., District Manager-Engineer
NOTE: /..
NO physical connection of the house sewer
to the lateral sewer shall be made until writ- '
ten permission istrcceived from the District.
TE:See Details on other side of this permit
CUPERT/NO SANITARY DISTRICT
NOTES: All valves to be accessible and malntoined by Property Owner.
Overflow point at least twelve inches(12") below lowest finished
floor containing plumbing.
Kelly Valve installed at Property Line to be readily removable
for Lateral Sewer maintenance.
e ,
o n Finish Fla r Level Finish Floor Level
Kell Valve
u E y Finish Grade e—
¢ Kelly Valve �iE
Valve Acesa CoreBppx —/ pp � in m'
with Venter p E Valve Access Box
dYlll' Backwater Valve
-Fl O
Figure I Figure 2 Figure 3
Kelly Valve- Below Surface Backwater Valve—Normally Kelly Valve-Above Ground
Ins1a11.1ian-Shawn or required installed at shallowest point Instollulion-Shawn installed
Property Line Cleauoul. along House Sewer between close To building.
Property Line and building.
OETAIL
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I
Distance from IL to be as
close as practicable,e.
Removable Cleanout Plug
a Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by properly owner.
Short length Riser Pipe
Adaptor coupling 1/8 Bend
_ FLOW m
Lateral Sewer I House $ewer
..y NOTE+ -Mnimum stop. determined by Building Department.
-Lateral Sewer Cleanout to be some
sue as Lateral Sewer. r
DETAIL
STANDARD CLEANOUT FOR LATERAL SEWER ,J