Permit # i Tri _SEWER CONNECTION PERMIT
q CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: SWR2010 -00067
• 1 Date Issued: 05/06/2010
`T f GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S136DC00400
Jurisdiction: Tigard
Site address: 11580 SW 72ND AVE
Subdivision: FRUITLAND ACRES Lot: 17
Project: Alcorn
Project Description: Sewer connection for existing residence. Sewer Reimbursement District #46 fee paid 5/6/10.
FEES
Owner:
ALCORN FAMILY TRUST Description Date Amount
19325 SW ROSA RD Sewer Connection Fee 05/06/2010 $3,600.00
ALOHA, OR 97007 Sewer Inspection - Residential 05/06/2010 $35.00
PHONE: 503 - 270 -6813
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $3,635.00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or r is s nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No ' cation Center. Th se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire question to OUNC by all 3.2 6699 or 1.800.332.2344.
Iss gd By: (typt.,4)
Permittee Signature:
40111f —
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.