Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00400
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/27/2004
SITE ADDRESS; 15020 SW 98TH AVE PARCEL: 2S111BD 00507
SUBDIVISION: DARMEL ZONING: R - 3.5
BLOCK: LOT: 007 JURISDICTION: TIG
TENANT NAME: GOLDEN
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection. Reimbursement District No. 27 PAID.
Owner:
FEES
GOLDEN, CAROL JEAN +
LONELL DARRIUS Description Date Amount
15020 SW 98TH [SWUSA] Swr Connectic 12/27/2004 $2,500.00
TIGARD, OR 97224 [SWUSA] Swr Connectic 12/27/2004 $0.00
Phone: 503 639 - 7699 [SWINSP] Sewer Inspect 12/27/2004 $35.00
[ SWINSP] Sewer Inspeci 12/27/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 obtain copies of these rules or direct questions to OUNC by calling (503) 246 - 6699.
Issued by: et. 4 / Permittee SignaturesL
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day