Permit CITY TIGARD SEWER CONNECTION PERMIT
*4 DEVELOPMENT SERVICES PERMIT #: SWR2003 -00347
A I- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/03
SITE ADDRESS; 10022 SW 70TH PL PARCEL: 1S136AA -08900
SUBDIVISION: VENTURA ESTATES ZONING: R - 4.5
BLOCK: LOT: 011 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 for new SF dwelling.
Owner: FEES
WINGATE CORP.
15840 S. POPE LANE. Description Date Amount
OREGON CITY, OR 97045 [SWUSA] Swr Connect 12/8/03 $2,400.00
[SWUSA] Swr Connect 12/8/03 $0.00
Phone: 503 657 - 3300 [SWINSP] Swr Inspect 12/8/03 $35.00
[SWINSP] Swr Inspect 12/8/03 $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" Perm
Issued by: _ GGr�i/ ,/.��L Permittee Signature: 4llir,P Q a
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed - - ness day