Permit CITY TIGARD SEWER CONNECTION PERMIT
�I, DEVELOPMENT SERVICES PERMIT #: SWR2003 - 00352
ry" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/14/03
SITE ADDRESS; 11500 SW 98TH AVE PARCEL: 1S135CD
SUBDIVISION: PP1994 -029 ZONING: R -4.5
BLOCK: LOT: 002 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: Sewer connection for new SF detached dwelling.
Owner:
FEES
MIKE PARKER CONSTRUCTION
16594 TIMBERLAND DR Description Date Amount
ALOHA, OR 97007 [SWUSA] Swr Connect 11/14/03 $2,400.00
[SWUSA] Swr Connect 11/14/03 $0.00
Phone: 503- 680 -0893 [SWINSP] Swr Inspect 11/14/03 $35.00
[SWINSP] Swr Inspect 11/14/03 $0.00
Contractor:
Total $2,435.00
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 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" Perm
Air
Issue by: , , j! , Ak. , / / / / Permittee Signature:
Call (503) 6 • • -4175 by 7:00 P.M. for an inspection needed t e next business day