Permit j CITY OF TIGARD SEWER CONNECTION PERMIT
ii DEVELOPMENT DEVELOPMENT SERVICES DATE IS 6/ 4/2004 -001 75
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13335 SW 107TH AVE PARCEL: 2S103DA -04103
SUBDIVISION: ZONING: R - 3.5
BLOCK: LOT: 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: Sewer connection for SF
Owner: FEES
BEN RILEY
13335 SW 107TH Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connectic 6/14/2004 $2,400.00
[SWUSA] Swr Connectic 6/14/2004 $0.00
Phone: 503- 723 -9309 [SWINSP] Sewer Inspect 6/14/2004 $35.00
[SWINSP] Sewer Inspeci 6/14/2004 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
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
Orego U .. - Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may o in copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issue by: L (G��, Permittee Signature: k \Ma ArDAQ)
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day