Permit CITY TI G A R D SEWER CONNECTION PERMIT
14 VIII it DEVELOPMENT SERVICES PERMIT #: SWR2004 -00331
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/11/2005
SITE ADDRESS; 07807 SW DUNE GRASS LN PARCEL: 2S112BA -09600
SUBDIVISION: BONITA TOWNHOMES ZONING: R - 12
BLOCK: LOT: 032 JURISDICTION: TIG
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: New SFA sewer connection.
Owner: FEES
JLS CUSTOM HOMES Description Date Amount
16280 NW BETHANY
BEAVERTON, OR 97006 [SWUSA] Swr Connection Fee 3/11/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 3/11/2005 $35.00
Phone: 503 - 533 - 4006 Total $2,535.00
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
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 obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issue. by: / �� Permittee Signatur (A--I
Call (503) 639 -4175 by 7:00 P.M. for an inspection the next 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.