Permit CITY TIGARD SEWER CONNECTION PERMIT
4l4 DEVELOPMENT SERVICES PERMIT #: SWR2003 -00039
AI! 13125 SW Hall Blvd., Tigard, O 97223 (503) 639 -4171 DATE ISSUED: 7118/03
SITE ADDRESS; 13745 SW 124TH AVE PARCEL: 2S103CC 06200
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 009 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 residence.
Owner:
FEES
DON MORISSETTE HOMES
4230 GALEWOOD ST Description Date Amount
STE 100 [SWINSP] Swr Inspect 7/18/03 $35.00
LAKE OSWEGO, OR 97035 [SWINSP] Swr Inspect 7/18/03 $0.00
Phone: 503- 387 -7538 [SWUSA] Swr Connect 7/18/03 $2,400.00
[SWUSA] Swr Connect 7/18/03 $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
I
Issued : , ;
/ ��; - � - Permittee Signature: , /• ti _� A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day