Permit CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 - 00344
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/3/03
SITE ADDRESS; 14050 SW 131ST TERR PARCEL: 2S109AB 07900
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 008 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: IMPERV SURFACE:
Remarks: Sewer connection for new SF dwelling.
Owner:
FEES
PIATSKI, BORIS
10625SW COTTONTAIL PL. Description Date Amount
BEAVERTON, OR 97008 [SWUSA] Swr Connect 11/3/03 $2,400.00
[SWUSA] Swr Connect 11/3/03 $0.00
Phone: 503 -313 -2406 [SWINSP] Swr Inspect 11/3/03 $35.00
[ SWINSP] Swr Inspect 11/3/03 $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
Issued by: e Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next / siness day