Permit a1
CITY OF TIGARD
PLUMBING PERMIT
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a COMMUNITY DEVELOPMENT Permit #: PLM2010 -00157
!' Date Issued: 05/14/2010
T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 136 DCO3500
Jurisdiction: Tigard
Site address: 11745 SW 70TH AVE
Subdivision: ELNOLA HEIGHTS Lot: 16
Project: Winkler
Project Description: 80' of sanitary sewer service to connect existing house.
Owner: FEES
WINKLER, ROBERT G Quantity Description Date Amount
LOUELLA D, 11745 SW 70TH
TIGARD, OR 97223 80 If Sewer Service 05/14/2010 $62.54
PHONE: 503-639-9376 1 12% State Surcharge - 05/14/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 05/14/2010 $9.96
Contractor: Plumbing
JACK HOWK PLUMBING /RESCUE ROOTER
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503- 491 -2932
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the 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 obtain a copy of the rules
or dir questions . • UNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed By: 1t Permittee Signat
_
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.
P.001
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J , . o � SEPTIC TANK DECOMMISSION (ABANDONMENT)
'r�/ b. ` �" { ' " For Onslte Sewage Disposal System
0111 ®Y I� '1 i
BUILDING �lV ,., , .- `, , Washington County Department of Health & Human Services
ce ;14 Environmental Health
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eec° 155 North First Avenue, MS 5, Suite 160 • Hillsboro, Oregon 97124 -30
Telephone (503) $46 -8722 gg id&O
Please return completed form to Washington County Department of Health & Human Se —
_._ . _ -alth
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Tawnsnlp Range ' Section Tax Lot # ( ."
s)
2. l l'Oer - 1 --- W /A
Printed Name of Property Owner
/194 ' Sl y 7D / �7.�.
3, The septic tank located at: `
Address City State Zi p Code
A /Vas pumped of sludge on:
Date: ' - )C1' ! D
By Licensed Operator: 14Z • ... License #: 3 1 1 q a,
❑ Was backfilied : .. - can bank run gravel AFTER being pumpe..f . fudge on:
Date: 5 - j q - I 0 Signature of Operate ,4
r t ; n A .c �, w y m e r , , i,:' , ,,, ,,,„'y - # . i ne r s y
" , Oregon Admirolstrative Rules 340 71 185 Decammissloni of Systems, . L. `
.,.f_ .,.a . '. a '� . , A„ u v.i n �. .d41 c.x�,. .. -, ,cm9t4 �,'� p Y i n
•, _.• M4� e ti-raf1��� Y d4o'+1� ,,iL�l�ta r, av r ,. ,,, , � ��7. r 1 y �, + uTj
1) The owner shall decommission a system when:
a) A sewerage system becomes available and the building sewer has been connected
thereto; or
b) The source of sewage has been permanently eliminated:
2) Procedures for Decommissioning:
a) The tank(s), cesspool or seepage pit shall be pumped by a licensed sewage disposal
service to remove all seepage;
b) The tank(s), cesspool or seepage pit shall be filled with reject sand, bar run gravel or
other material approved by the Agent, or the container shall be removed and properly
disposed.
The septic tank at the address above has been decommissioned in accordance with Oregon Administrative
Rules.
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Signature of Property O wn . vii„ 9 P Y „
WCDHHS EH Rrviaed April 2007
TOTAL P.001