Permit CITY TIGARD SEWER CONNECTION PERMIT
4,, DEVELOPMENT SERVICES PERMIT #: SWR2003 -00079
— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/11/03
SITE ADDRESS; 10998 SW 68TH PKWY PARCEL: 1S136AD -06505
SUBDIVISION: WAY LEE ZONING: C -
BLOCK: LOT: 003 JURISDICTION: TIG
TENANT NAME: BANK OF TIGARD
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.7 EDU increase. Previous EDU = 0. This permit 27 fixture values = 1.7 current EDU's.
Owner: FEES
BANK OF SALEM
PO BOX 847 Description Date Amount
SALEM, OR 97308 [SWUSA] Swr Connect 3/11/03 $3,910.00
[SWUSA] Swr Connect 3/11/03 $0.00
Phone: 503 - 585 - 5290
Total $3,910.00
Contractor:
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" Perm
Issued by: Ica /i•1 _( MA) Permittee Signature: 1 /AifiO,A4
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•