Permit C ITY OF TI GARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00252
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� DATE ISSUED: 10/12/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 06770 SW ALFRED ST PARCEL: 1S125DA-12000
SUBDIVISION: LAWRENCE PARTITION ZONING: R - 4.5
BLOCK: LOT: 001 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 detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO
THIS PERMIT.
Owner: FEES
ROBERT H. LAWRENCE
15840 SW BOBWHITE CIRC Description Date Amount
BEAVERTON, OR 97007 [SWUSA] Swr Connectic 9/28/2004 $2,500.00
[SWUSA] Swr Connectic 9/28/2004 $0.00
Phone: 503- 975 -6560 [SWINSP] Sewer Inspeci 10/12/2004 $35.00
[SWINSP] Sewer Inspeci 10/12/2004 $0.00
Contractor:
Total $2,535.00
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"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon • • Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may taro copies f these rules or direct questions to OUNC by calling (503) 246 -6699.
Iss d by: / } Permittee Signatur Gk
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next mess day