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P-15682 . ._ ,:. �° PERMIT P-15662 CUPERTINO SANITARY DISTRICT' Santa Clara County 20065 Stevens Creek Blvd., Bldg C, Fax (408)253-5173 Cupertino, California 95014 Phone (408) 253-7071 O CONNECTION PERMIT S -7 R.O.S./P.M./Tract No. Lot No. A.P.N.: Book360 _Page-0 L Parcel 40 Date , Property Owner: t a55 t c Mailing Address: (/l it— (If different) 1A crih„� Telephone: Sirs: (I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at: iD / 70 z-A V 1 A,(JeS 72,�U 6 consisting of the following TYPE OF BUILDING(S): Residential: Single Family V ; Multiple Family , 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. 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 C ,�d� Building Department 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 (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 issuan%t§of an 'encroachmeni permit for sewer construction in the street/public right-of-way of the agency having jurisdiction thereover. i 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): © 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: $ / Sewer Service charges to June 30, 19�, $ /mo. x S mo.: $ ��`/ Inspection Fee for backflow protection device: $ 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 voidthispermit. Acknowledgment: Owner's Agent: 'e:2ef- 1/C ON (print name) Receipt of$ 2Z11 1 acknowledged and permit granted. MARK THOMAS& 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, °i not to exceed five(5) feet. J a Removable Cleanout Plug n 0 Q. 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 Lateral Sewer I House Sewer Lateral Sewer slope I House Sewer slope determined by District determined by building deportment —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. r TYPICAL BACKFLOW PROTECTIVE DEVICE INSTALLATION TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS INSTALLATION Jurisdictional Restrictions Accented ey All Jurisdictions FIGURE I FIGURE 2 FIGURE 3 immlled eemw Grade Installed Below Grade Installed Above Grade Shown Between Street Right.at-Way and Building Shown At Proaerly Line aeadaw shown Adioceni To Building Requires Regular Maintenance 2 Required Minimum Maintenance Requires Minimum Maintenance Valve To Be Removable valve Should Ra Removable * VALVE ACCESS 60% FINISH FLOOR ¢ wit IVented Bauer p Level of FINISH FLOOR KELLY VALVE AJIKELLY Finish Grade VALVE ACCESS BO% VALale VE Finish Grade _E Finish Grade it f BACKWATER �/ m VALVE FLOW Dl FLOW 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.