Permit _ -..
71 CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00292
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/29/2007
PARCEL: 2S 103RD - 01200
SITE ADDRESS: 12630 SW 121ST AVE ZONING: R -4.5
SUBDIVISION: NIX PARTITION LOT: JURISDICTION: TIG
PROJECT: NIX
Project Description: Connect existing house to sewer service.
TENANT NAME: NIX
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
LOY & MARS NIX FEES
12630 SW 121ST Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 11/29/2007 $2,800.00
[SWINSP] Sewer Inspection Fee 11/29/2007 $35.00
Phone: 503 -590 -4810
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699
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by : �l / kjA_O_O , Permittee Signature:
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.