Permit CITY TI GARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00102
i , D EVELOPMENT SERVICES
' DATE ISSUED: 5/7/03
I 13125 SW Hal Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 14270 SW 128TH PL PARCEL: 2S109AA -05300
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R - 7
BLOCK: LOT: 019 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
PAUL R. CARNEY
1480 NW 102ND Description Date Amount
PORTLAND, OR 97229 [SWUSA] Swr Connect 5/7/03 $2,300.00
[SWUSA] Swr Connect 5/7/03 $0.00
Phone: 503 939 - 7285 [SWINSP] Swr Inspect 5/7/03 $35.00
[ SWINSP] Swr Inspect 5/7/03 $0.00
Contractor:
Total $2,335.00
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: _�� „,/,, , 46 :41_, , Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day