Permit A l hb CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR1999 -00083
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/19/99
SITE ADDRESS; 14225 SW 116TH TERR PARCEL: 2S1106A -08800
SUBDIVISION: EVERGREEN SPRINGS ZONING: R -4.5
BLOCK: LOT: 013 JURISDICTION: TIG
TENANT NAME: RENAISSANCE CUSTOM HOMES
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
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068 PRMT DST 7/19/99 $2,300.00 99- 316963
INSP DST 7/19/99 $35.00 99- 316963
Phone: 557 -8000 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 these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: Permittee Signatur• i ��� _ _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day