Permit CITY TI GA R D SEWER CONNECTION PERMIT
CIA DEVELOPMENT SERVICES PERMIT #: SWR2004 -00342
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/8/2004
SITE ADDRESS; 16101 SW 72ND AVE BLDG A -200 PARCEL: 2S113A6 -00101
SUBDIVISION: ZONING: IP
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 7
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .4 EDU increase for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [SWUSA] SwrConnectic 11/8/2004 $1,000.00
[SWUSA] Swr Connectic 11/8/2004 $0.00
Phone: 503- 624 -6300
Total $1,000.00
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"
Permi a -: -.Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the
Ore •on Utility Notitx ation Center. Those rules are set forth in OAR 952 - 001 -0010 through OA 52 -001 ! 4 0. You
m. obtain copies o hese • les or direct questions to OUNC by calling (503) 246- 6699.
Issu: • by: / _/ < Permittee Signature: At_ _ _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n business day