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