Permit CITYOFTIGARD DEVELOPMENT SERVICES SEWER CONNECTION
. J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT
PERMIT #.......: SWR99 - -0041
DATE ISSUED: 02/22/99
PARCEL: 2S111CB -05100
SITE ADDRESS... :15165 SW 100TH AVE
SUBDIVISION •PP1997 -058 ZONING: R -3.5
BLOCK LOT •001 JURISDICTION: TIG
TENANT NAME •BLAIS
USA NO • FIXTURE UNITS...: 0
CLASS OF WORK...: NEW DWELLING UNITS..: 1
TYPE OF USE -SF NO. OF BUILDINGS: 1
INSTALL TYPE - LTPSWR IMPERV SURFACE: 0 sf
Remarks: Sewer connection for SF dwelling. Septic tank to be pumped, filled and
inspected.
Owner: - - -- FEES
GREGORY M BLAIS type amount by date recpt
15165 S.W. 100TH AVENUE PRMT $ 2300.00 DLH 02/22/99 99- 313109
TIGARD OR 97223 INSP $ 35.00 DLH 02/22/99 99- 313109
Phone #: 632 -6138
Contractor:
OWNER
Phone #: • $ 2335.00 TOTAL
Reg #..:
-• REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days from Septic Tank Fill
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 -0001 -0080. You may obtain copies of
these rules or direct questions to OUdC by calling (503)246 -1987.
Issued by• Permittee Signature: j > - �,
VI
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Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
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