Permit •
C ITY OF TIGARD SEWER CONNECTION PERMIT
i DEVELOPMENT SERVICES • PERMIT #: SWR2006 -00083
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�� 13125 SW Hall Blvd., Tigard, OR 97223- 503 - 639 -4171 DATE ISSUED:' 7/25/2006
PARCEL: 1 S136CB -PR003
SITE ADDRESS: 11243 SW 82ND.AVE ZONING: R - 4.5
SUBDIVISION: PACIFIC RIM PROP PARTITION LOT: 003 JURISDICTION: TIG
Project Description: New SF sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE: •
Owner: FEES
PAC RIM HOMES
5700 NW EL REY DR Description Date Amount
CAMAS, WA 98607
[SWUSA] Sewer Connection Fee 7/6/2006 $2,600.00
[SWINSP] Sewer Inspection Fee - 7/6/2006 $35.00
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Phone: 360 - 833 -4572
Total $2,635.00
Contractor:
•
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Contact #: REQUIRED ITEMS AND REPORTS
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 you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may rain c pies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
i Permittee Signature: l ,
Issue by� (� , 9 L - �___. ,
Call 503-639-4175 by 7:00 a.m. for an inspection that busines 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.