Permit CITY TIGARD SEWER CONNECTION PERMIT
I, DEVELOPMENT SERVICES PERMIT #: SWR2000 -00208
.� I" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/22/2000
SITE ADDRESS; 15180 SW 84TH AVE PARCEL: 2S112CB -17500
SUBDIVISION: HAMPTON COURT ZONING: R -7
BLOCK: LOT: 024 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: DWELLING UNITS: 1
TYPE OF USE: NO. OF BUILDINGS:
INSTALL TYPE: IMPERV SURFACE:
• Remarks:
Owner: FEES
LEGEND HOMES Type By Date Amount Receipt
12755 SW 69TH
SUITE 100 PRMT DLH 08/22/200C $2,300.00 0004644
PORTLAND, OR 97223 INSP DLH 08/22/200C $35.00 0004644
Phone: 503 - 620 -8080 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations 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 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: Permittee Signat e: i f
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day