Permit CITYOFTIGARD
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A„ ,, DEVELOPMENT SERVICES SEWER CONNECTION
i PERMIT
-�'' 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 PERMIT #.......: SWR97 - 0140
DATE ISSUED: 07/30/97
PARCEL: 1S136DB -02600
SITE ADDRESS...:11201 SW 72ND AVE
SUBDIVISION • ZONING: C —G
BLOCK LOT • JURISDICTION: TIG
TENANT NAME •MCDONALDS
USA NO • FIXTURE UNITS...: 115
CLASS OF WORK...: NEW DWELLING UNITS..: 7
TYPE OF USE :COM NO. OF BUILDINGS: 1
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: RE: PLM97-0162
Owner: FEES
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 15400.00 B 07/30/97 97- 297741
LAKE OSWEGO OR 07035 INSP $ 45.00 B 07/30/97 97- 297741
GUN $ 3516.00 B 07/30/97 97- 297741
Phone #: EROS $ 80.00 B 07/30/97 97- 297741
ERPU $ 26.00 B 07/30/97 97- 297741
Contractor: - -ERPC $ 26.00 B 07/30/97 97- 297741
OWNER
Phone #: $ 19093.00 TOTAL
Reg #.. .
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect i o n
of the Unified Sewage Agency. 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- %10 through OAR 952 -0001 -0080. You may obtain copies of
these rules or direct questions to OUNC by calling (503)246 -1987.
Miag4A- ' T '"T Issued by: Permittee Signature: viii.
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Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
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Tenant Name: M It s. A". 1 4, ' 5 Accumulative Sewer Tally This SWR #: ' c I yO
Address: ���� t
I � / j 7Z(' `J This PL1N #: '"fo �0�
r K6U &Ai
Rxture Value Previous # Previous Cretins Capped Fixtures Rxtures New New
Value Capped off value ' added # added total #s total
Count of #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
• Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4 A i L�—
• Domest 2 /
Drinking Fountain 1
Eye Wash 1
•
Roor Drain /sink - 2 inch 2 _I P- (p (.-
- 3 inch 5 _ 14 -7- 1c
- 4 inch 6 V a ,
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2
- Bradley 5
- Commercial 3
- Service 3 11111 Swimming Pool Ftter 1
Washer, Clothes 6 i A.
Water Extractor 8
Water Closet. Toilet 6 I S
Urinal 6 MOR1 ( 6
TOTALS -__ En • / i<
Total fixture values: f /5 divided by 16 = . - EDU
HISTORY
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