Permit • A CITY OF TI GARD SEWER CONNECTION PERMIT
1; DEVELOPMENT SERVICES PERMIT #: SWR2000 -00121 II
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" ' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/11/2000
SITE ADDRESS; 13355 SW 128TH PL PARCEL: 2S104DA -02500
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: SF PATH I
Owner: FEES
JESS ALWAY, INC.
24300 STAFFORD RD Type By Date Amount Receipt
TUALATIN, OR 97062 PRMT DLH 07/11/200C $2,300.00 0003627
INSP DLH 07/11/200C $35.00 0003627
Phone: 638 -0718 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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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 expire . The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the meas re ' ent,& iven, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the inst- - - e a "Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law r-. :. 511111V4iC
��.yy rules adapted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 I'(I •, 471 -'. .Y-0i -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) ' s` 1 & j//
Issued by: Permittee Signature: 4ig
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nex � d • y ,.