Permit CITY TI D SEWER CONNECTION PERMIT
46. DEVELOPMENT SERVICES PERMIT #: SWR2004 -00146
I 13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171 DATE ISSUED: 6/9/2004
SITE ADDRESS; 12420 SW WINTERVIEW DR PARCEL: 2S1106C -04300
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 014 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection.
Owner: FEES
• DON MORISSETTE HOMES Description Date Amount
4230 GALEWOOD ST
STE 100 [SWUSA] Swr Connecti( 6/9/2004 $2,400.00
LAKE OSWEGO, OR 97035 [SWUSA] Swr Connectic 6/9/2004 $0.00
Phone: 503- 387 -7538 [SWINSP] Sewer Inspeci 6/9/2004 $35.00
[SWINSP] Sewer Inspect 6/9/2004 $0.00
Contractor:
Total $2,435.00
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 you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may • = r n copse these rules or •:. ect questions to OUNC by calling (503) 246 -6699.
Is. ued by: � � d � , �� �
,� ��/ � � ' , Permittee Signature: k
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day