15219 / 4�
SERIAL t u
SEWER CONNECTION PERMIT NO. P " 15219
CUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No..7995. Lot No.)9-`�....
20065 Stevens Creek Blvd. A.P.N. Bk...3.x'.0 .... Pg.D.9..... Par.�.'y.9...
Building C
Cupertino, California 95014 f
Phone (408) 253-7071 Date.Y 6' n V 0 M....z 119 199 Z.
The undersigned,being the owner((or owner's agent)of thepropertylocated at ........................................................
.......�1..-2.'.'.9.....S+C`.V :`.�...�.r..:..�`).1. eN'� Yt U
..........................................................................
consisting of the following TYPE OF BUILDING:
Residential: Single family...x...... 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 existing District easement. (Note—Detail✓)
• 3) To acquire a permit from the ...C!4r) 4?.?1....�?. E T.h p ... BuildingDepart-
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 prion to starting construction of the house sewer.
Iew e—
Property Owner's Name—P+ ! 1{?.. t,n .!.. .. Telephone......
Mailing address if 1 //
different from above... /2 .Wp
By1.G. r.� n ? 9Sa
. ... ..... . ....
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..........
.....................................
A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above
property.(Note—See Detail/)
FEES:
Connection Permit Fee $
GL
Sewer Service charges to June 30, 19 1.9.7:,$.,�Q.0.-....../mo. x.2-.mo. ...*2,�
Inspection Fee for backflow protection device
'c
TOTAL $
•eceipt of$.l��" .... acknowledged and permit granted. MARK THOMAS&CO. INC., Distric Manager-Engineer
BY �...............................
k
NOTE.,See Details on other side of this permit,
i
" CUPERT/NO SAN/TARP D/STR/CT "
NOTES: All valves to be occoorial. and maintained by Property Owner,
Overflow point of least twelve inahes(12") below lowest finished
floor containing plumbing.
Kelly Valve installed at Property Line to be readily removable
for Lateral Sewer maintenance.
J
^' IN SM1_Floor Level Finish Floor Level
d E Kelly Valva
Finish Grade =
Kelly Valva n
Valve Access 6 as in-
len
wllb Vented Cover Q �E Volvo Access Box
Backwater Valve
-Fl —�
Figure I Figure 2 Figure 3
Kelly Valve- Below Surface Backwater Valve-Normally Kelly Volve-Above Ground
mal lotion-Shown of required installed at shallowest point Inslallullon-Shown installed
Properly Line Cleonoul. along House Sewer between close to building. •
Property Line and building.
DETAIL
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I
Delores tram R Iq be as
close as practicable.
J
Removable Clsonout Plug
a. Finish Grade
Wye for Riser
Sewer Cleanout Box with Lo to be occeesible
and malnfolned by property owner.
Shur! le n.glM1 �Rls ar Pipe
Adop Nr sou piing 1/8 Bend
_ FLOW A
M Lateral SewerHouse Sewe TE� � nlmu
ryI�- m slope determined by Building Department,
J� Lateral Sewer Cleanout to be same
TT sixe as Lateral Sewer. •
DETAIL
STANDARD CLEANOUT FOR LATERAL SEWER J