Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
i l DEVELOPMENT SERVICES PERMIT #: SWR2004 -00197
411 . DATE ISSUED: 7/2/2004
13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 06855 SW BAYLOR ST PARCEL: 1S136DD -01300
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: TILLAMOOK FOOD SALES
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .3 EDU increase.
Owner: FEES
MALCOLM ESLINGER
11575 SW PACIFIC HWY Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connectic 7/2/2004 $750.00
[SWUSA] Swr Connectic 7/2/2004 $0.00
Phone: 503- 620 -9515
Total $750.00
Contractor:
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 Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
/ _ � P Si natur — Issued by: -� t �� �-/z 9 /l- � dOrdp
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• Accumulative Sewer Tally Parcel # 1513600- 01300
Tenant Name: Tillamook Cheese
Site Address: 6855 SW Baylor St, This SWR#004 -00197
This P LM# Q 4 -oo310
Fixture Value Previous Previous Credits Capped Fixture Fixture New
New
# value capped off value added added total total
count , #s count # value #s
Baptisery/Font 4 va
0
0 0 0
Bath - Tub /Shower 4 0
0 0 0 0
Jacuzzi/Whirlpool 4 0
0 0 0 0
Car Wash - Each Stall 6 0
0 0 0 0
Drive through 16 0
0 0 0 0
Cuspidor/Water Aspirator 1 0
0 0 0 0
Dishwasher - Commercial 4 0
0 0 0 0
- Domestic 2 0
0 0 1 2 1
Drinking Fountain 1 2
0
Eye Wash 1 0 0 0 0 0
0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0
0 0 0
- 3 inch 5 0 0
0 0 0
- 4 inch 6 0 0
0 0 0
- Car Wash Dr 6 0 0
3arbage Disposal 0 0 0
- Domestic (to 3/4 HP) : . , ,
16 0 0
- Commercial (to 5 HP) 32 0 0 0
0 0 0 0 0
- Industrial (over 5 HP) 48 0 0
ce Machine /Refrigerator Drain 1 0 0 0
0 0 0 0 0
)il Sep (Gas Station) 6 0
0 0 0 0
Zec. Vehicle Dump station 16 0 0
hoover Gang (per head) 1 0 0 0 0
0 0 0 0
- Stall 2 0
0 0 0 0
ink - Bar /Lavatory 2 0
- Bradley 5 0 0 0 0 0
0 0 0 0
- Commercial 3 0
Service 3 0 0 0 0 0
0 1 3 1 3
wimming Pool Filter 1 0
0 0 0 0
( asher - Clothes 6 0 0
'ater Extractor 0 0 0
6 0 0 0
ater Closet Toilet 6 0 0
0
Ina' 6 0 0 0 0 0
0 g 0 0 0
Previous EDU Count h 0
Capped EDU Credit 0 #5 a 0
)TALS 0 0 0
0 0 2 5 2 5
Current Fixture Value 5 divided by 16 = 0.3 Current EDU
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU 1 EDU = $ 2,500
Change 5 divided by 16 = 0.3 over (under) $ 750.00
Enter EDU Change Here :ls$
, tes:
Name: a ,Qi it i6(..<244...) )
Date: 7/z/94/
Building Division
Note: The property owner shall retain this record for sewer credit purposes. In the event of a credit, this
document stamped "ORIGINAL" shall serve as a credit voucher and must be submitted to the City of
Tigard Building Division to redeem credit towards future system development charges.