Permit CITY TIGARD SEWER CONNECTION PERMIT
r 1 DEVELOPMENT SERVICES PERMIT #: SWR2000 -00128
..�Y DATE ISSUED: 7/6/00
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 15210 SW 107TH TERR PARCEL: 2S110DA -EH028
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 028 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: S/F PATH I
Owner: FEES
RENAISSANCE DEVELOPMENT Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068 PRMT DEB 7/6/00 $2,300.00 0003517
INSP DEB 7/6/00 $35.00 0003517
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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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 Ore tility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You m obtain cop s of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue by: ► I ' / I I , Permittee Signature
Call (503 .39-4175 by 7:00 P.M. for an inspection needed the next business day