Permit n
II
CITY O F TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00095
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/12/2008
PARCEL: 25101 DC - 02900
SITE ADDRESS: 07595 SW CHERRY ST ZONING: R -3.5
SUBDIVISION: ROLLING HILLS PLAT 2 LOT: 047 JURISDICTION: TIG
PROJECT: CHICK
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #44.
Fees paid 6/12/2008.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
MARIBETH CHICK FEES
11575 SW PACIFIC HWY #120 Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 6/12/2008 $2,800.00
[SWINSP] Sewer Inspection Fee 6/12/2008 $35.00
Phone: 503- 639 -7362
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
r
Reg #: .
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
or 1.800.332.2344.
Issued ,. Permittee Signature: ) e I )
Call 503.639.4175 by 7:00 a.m. for an inspection that siness day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.