Permit CITY OF TIG R® SEWER CONNECTION PERMIT
v V TIGARD
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00117
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/21/2007
PARCEL: 2S 103DA -01700
SITE ADDRESS: 10785 SW DERRY DELL CT ZONING: R -3.5
SUBDIVISION: DERRY DELL PLAT 2 LOT: 017 JURISDICTION: TIG
PROJECT: TIPTON
Project Description: Connect to sewer service. Sewer Reimbursement District #29 fee paid 5/21/07.
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: FEES
TROY & MICH TIPTON
10785 SW DERRY DELL CT Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 5/21/2007 $2,700.00
[SWINSP] Sewer Inspection Fee 5/21/2007 $35.00
Phone: 503- 620 -3511 Total $2,735.00
Contractor: •
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REQUIRED ITEMS AND REPORTS
Cont 16tr C od Nt
Reg fJ A
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 I � QQ(/V1/1_ , C Permittee Signature: al_ L
Call 503.639.4175 by 7:00 a.m. for an inspection that business • .y.
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.
RETURN RECORDED DOCUMENT TO:
CITY HALL RECORDS DEPARTMENT;
CITY OF TIGARD
13125 SW Hall Blvd.
Tigard, OR 97223 COpY
File No. Reimbursement District # 29
City of Tigard
Sewer Reimbursement District
Deferral Agreement
City of Tigard Resolution No. 03 -55 provide that payment of certain portions of reimbursement fees
imposed on lot owners who have connected to sewers construction through City Reimbursement Districts
(Tigard Municipal Code Chapter 13.09) may be deferred until the lot is developed.
The undersigned owner(s) of the real property described below do hereby acknowledge deferral in the
amount of $704.00 and record their agreement to pay this amount to the City of Tigard upon partitioning or
otherwise developing the property in accordance with Resolution No. 03 -55. The obligation to pay this
deferred amount transfers to purchasers upon sale of the real property.
The real property that is the subject of this agreement is Lot 17 Derry Dell Plat 2, recorded as Book 16 Page
37, Washington County (Tax Lot 2S103DA lot 01700, addressed as 10785 SW Derry Dell Court).
IN WITNESS WHEREOF, I hereunto set my hand on this 2 t day of m 4-ei , 2007
- ci `i P l i P l6 & illt, hake, T I r von
Print N e �� \\ �� Print Name ( /
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Signature Signature
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Address Address
yr'2d c)( C1 1 . 4 1 l u DE Q '1 2d
STATE OF OREGON )
) ss.
County of Washington )
Thispstrument yias ac 'owledged before me ofi- date) by.
' 0 y f • `) i 1 r _ 6 0 l i i(JT(m (name of person(s)).
Notary's Signature I
• a OFFICIAL SEAL �' � n �
, ROBERT A ROWE My Commission Expires: ! � � o'�J r
.- " := N OTARY PUBLIC- OREGON
,: COMMISSION NO 12148
MY C O MM ISSION EXPIRES NOVEMBER 21, 2010 ot St
Accepted on behalf of the City of Tigard this
-.-.7 1 day of May , 2007
Y
Q p, a
. ty Engineer
NO CHANGE IN TAX STATEMENT