Permit CITY T I GA RD SEWER CONNECTION PERMIT
Im" DEVELOPMENT SERVICES PERMIT #: SWR2004 -00404
��111 1312 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/11/2005
r a v gar PARCEL: 2S112CD -12300
SITE ADDRESS: 16018 SW 77TH TERR ZONING: R - 12
SUBDIVISION: HAMBACH GROVE LOT: 021 JURISDICTION: TIG
Project Description: New SFA sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
LEGEND HOMES
12755 SW 69TH Description Date Amount
SUITE 100 [SWUSA] Sewer Connection Fee 7/11/2005 $2,600.00
PORTLAND, OR 97223 [SWINSP] Sewer Inspection Fee 7/11/2005 $35.00
Phone: 503 - 620 - 8080 Total $2,635.00
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 y•u to fol •w rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throug • e R 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling 5ic- 246 -∎ 1:11-1 44 !-
Issued by: _____________ Permittee Signature: , 1
Call 503- 639 -4175 by 7:00 a.m. for an inspection that 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.