Permit CITY T I GARD SEWER CONNECTION PERMIT
�r I� DEVELOPMENT SERVICES PERMIT #: SWR2004 -00306
���I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/4/2004
SITE ADDRESS; 15065 SW 94TH AVE PARCEL: 2S111DB -16500
SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R - 4.5
BLOCK: LOT: 022 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: New SF sewer connection .
Owner: FEES
BUENA VISTA HOMES Description Date Amount
6932 SW MACADAM #C
PORTLAND, OR 97219 [SWUSA] Swr Connectic 11/4/2004 $2,500.00
[ SWUSA] Swr Connectic 11/4/2004 $0.00
Phone: 503- 443 -6033 [SWINSP] Sewer Inspect 11/4/2004 $35.00
[SWINSP] Sewer Inspeci 11/4/2004 $0.00
Contractor: Total $2,535.00
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 ewer 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 Util" Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may in copie f these rules or direct questions to OUNC by calling (503) 246 -6699.
Is ed by: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day