Permit CITY TIGARD SEWER CONNECTION PERMIT
Al DEVELOPMENT SERVICES PERMIT #: SWR2004 -00137
AI DATE ISSUED: 6/4/2004
13125 SW Hall B lvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 11114 SW 108TH AVE PARCEL: 1S134DA -01901
SUBDIVISION: ZONING: R - 4.5
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 new SF dwelling.
Owner:
FEES
GRANT, JIM Description Date Amount
11865 SW SCHOLLWOOD CT.
TIGARD, OR 97223 [SWUSA] Swr Connectic 6/4/2004 $2,400.00
[SWUSA] Swr Connectic 6/4/2004 $0.00
Phone: 503 -579 -1088 [SWINSP] Sewer Inspect 6/4/2004 $35.00
[SWINSP] Sewer Inspeci 6/4/2004 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #: MET 00004318
LIC 109110
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 fol • ules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0011 oug• OAR 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503 46-669'.
Issued by: A.,„ 1 _, Permittee Sig ature• J, < <., , 4c6 , 4f
Call (503) 639 -4175 by 7:00 P.M. for an inspection need- • the next business day