Permit .
CITY TIGARD SEWER CONNECTION PERMIT l DEVELOPMENT Tigard, SERVICES ) 639 -4171 DATE PERMIT #: ISSUED: 1/2 0403 00393
13125 SITE ADDRESS; 14550 SW 120TH PL PARCEL: 2S1106C -09800
SUBDIVISION: WALL PARTITION2 /MLP2003 - 00001 ZONING: R - 7
BLOCK: LOT: 002 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
Owner: FEES
MASTERPIECE CONSTRUCTION INC
14225 SW 128TH PL Description Date Amount
TIGARD, OR 97224 [SWUSA] Swr Connect 1/20/04 $2,400.00
[SWUSA] Swr Connect 1/20/04 $0.00
Phone: 503 -524 -4371 [SWINSP] Swr Inspect 1/20/04 $35.00
[SWINSP] Swr Inspect 1/20/04 $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" Perm
Issued by: ; �,1 �� Permittee Signatures 41N
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next business day