Permit CITY TIGARD SEWER CONNECTION PERMIT
1 DEVELOPMENT SERVICES PERMIT #: SWR1999 - 00257
+�- 4 � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/6/99
SITE ADDRESS; 12385 SW 106TH DR ORtGNAL PARCEL: 2S103AA -01909
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
TENANT NAME: FLATTERS
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 sewer lateral as part of Reimbursement District #12. Reimbursement fee of
$5,597.82 paid on 12/6/99. Septic tank to be pumped, filled or removed and inspected.
Owner:
FEES
FLATTERS, JAMES G Type By Date Amount Receipt
LORAINE M
12385 SW 106TH AVE PRMT DEB 12/6/99 $2,300.00 99- 320185
TIGARD, OR 97223 INSP DEB 12/6/99 $35.00 99- 320185
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 -0010 through OAR 952 - 001 -0080.
You Obtain'•- •ies of these r -s or direct questions to OUNC by calling (503) 246 -1987.
Issu d by: �j /w aa /1,120 Permittee Signature;- AI .
Call (503) 63: -4175 by 7:00 P.M. for an inspection needed t - • usiness day