Permit CITY TIGARD SEWER CONNECTION PERMIT
Ir e DEVELOPMENT SERVICES PERMIT #: 4/5/00 0 -00060
All SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/5/00
SITE ADDRESS; 14975 SW 103RD AVE PARCEL: 2S111CB -01100
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 010 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: Connection to newly installed sewer service. Septic system must be prumped, filled and inspected.
Reimbursement District #16 fee paid on 4/5/00,
receipt # 0001158.
Owner:
FEES
HUMMEL, DENNIS AND JUDY A
14975 SW 103RD AVE Type By Date Amount Receipt
TIGARD, OR 97223 PRMT DEB 4/5/00 $2,300.00 0001158
INSP DEB 4/5/00 $35.00 0001158
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 952-001-0410 through OAR 9 " -• ' -0080.
You m obtai pies of these rules or direct questions to OUNC by calling (503 246- •87.
Issued y: Ab 1FLt l LGQ (62- Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business da