Permit CITY TIGARD SEWER CONNECTION PERMIT
1.00,00( DEVELOPMENT SERVICES D ATEERMIT #. sw100 -00343
'- I 13125 SW Hall Blvd.j OR 97223 (503) 639 -4171
SITE ADDRE'SSL 14530 SW 100TH AVF� PARCEL: 2S111BD -00301
SUBDIVISION: P HTS ZONING: R -3.5
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection. Reimbursement District #13 fees of $8,000.00 paid on 11/1/00.
Owner:
FEES
QUINN, DONALD R JR
SHIRLEYA Type By Date Amount Receipt
14530 SW 100TH PRMT CTR 11/1/00 $2,300.00 27200000000
TIGARD, OR 97223 INSP CTR 11/1/00 $35.00 27200000000
Phone: 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: ` � `!r_ Permittee Signature
03) 639 -4175 by -Z`00 P.M. for an inspection needed the next business day