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Permit 14 CITY TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT #: SWR2000 - 00103 . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/16/2000 SITE ADDRESS; 13530 SW 121ST AVE PARCEL: 2S103CD - 04400 SUBDIVISION: ZONING: R - 4.5 BLOCK: LOT: JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Connection of sewer lateral. Septic tank to be pumped, filled and capped or removed and inspected. Owner: FEES BROWN, MICHAEL J + RIES, JUNITA M Type By Date Amount Receipt 13530 SW 121ST AVE PRMT KJP 05/16/200C $2,300.00 0002227 TIGARD, OR 97223 INSP KJP 05/16/200C $35.00 0002227 Phone: Total $2,335.00 Contractor: Phone: Reg #: Required Inspections Sewer Inspection Septic Tank Filled 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 p ese rules or direct questions to OUNC by calling (503) 246 -1987. Issued by: Permittee Signature: / / 041.fil Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day