Permit CITY OF TIGARD
SEWER CONNECTION PERMIT
?� COMMUNITY DEVELOPMENT' Permit #: SWR2010 -00030
r 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/08/2010
T6GARD Parcel: 1S136DB02700
Jurisdiction: TIGARD
Site address: 11026 SW 74TH AVE
Subdivision: WHITE OAK PARTITION Lot: 1
Project: White Oak Village Partition
Project Description: Connect new SFR to sewer.
FEES
Owner:
DALTON, LOREN & ANNETTE Description Date Amount
414 ASHLAND CT Sewer Inspection - Residential 07/08/2010 $35.00
CAMERON PARK, CA 95682
PHONE: 530 - 676 -4144
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of'Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $35.00
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 if work is.suspended for more the 180 days. ATTENTION: Oregon taw requires you to follow the rules adopted by the Oregon
Utility Notif on Center, ho rules are set forth in OAR 952- 001 -0010 through OAR 952 -001- 0100. You may obtain a copy of the rules
or dir:0n0;00 r byc•Ilin• . 11 246699 or 1800:332.2344. d "B y ; /� // / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept 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.