Permit A • CITY OF TI GARD SEWER CONNECTION PERMIT
�I�Y PERMIT* SWR2000 -00094
DEVELOPMENT SERVICES DATE ISSUED: 05/16/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 12980 SW 113TH PL PARCEL: 2S103AC FON09
SUBDIVISION: FONNER WOODS ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
TENANT NAME: K & W DEVELOPMENT
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: Sewer connection for a new single family dwelling.
Owner: FEES
K & W DEVELOPMENT Type By Date Amount Receipt
9155 SW RAMBLER LN
PORTLAND, OR 97223 PRMT GEO 05/16/200C $2,300.00 0002205
INSP GEO 05/16/200C $35.00 0002205
Phone: 503 - 245 -9167 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
ORIGINAL
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 may obtain copies of th- a les or d ect questions to OUNC by calling (503) 246 -1987.
Alr Alfr
Issued by: Permittee Signature:
Call (503) 63•/ 175 by 7:00 P.M. for an inspection needed the next business day