Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
i I . DEVELOPMENT SERVICES PERMIT #: SWR2004 -00305
64 DATE ISSUED: 10/26/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 07357 SW BEVELAND RD PARCEL: 2S101AB -01606
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 017 JURISDICTION: TIG
TENANT NAME: CLARKE OFFICE BUILDING
USA NO: FIXTURE UNITS: 37
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 2.3 EDU's for new office building.
Owner: FEES
TOM CLARKE Description Date Amount
12448 SW ORCHARD HILL RD
LAKE OSWEGO, OR 97035 [SWUSA] Swr Connecti( 10/26/2004 $5,750.00
[SWUSA] Swr Connectic 10/26/200z $0.00
Phone: 503- 293 -1226 [SWINSP] Sewer Inspeci 10/26/2004 $45.00
[SWINSP] Sewer Inspeci 10/26/200 $0.00
Contractor:
Total $5,795.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires y•u o • •w ru - . • •pted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-001i through 0 ' 95. - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 246 • 99.
Issued b Permittee Signature: ,'
y Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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