Permit CITY TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00154
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/8/2008
PARCEL: 1 S134DB -BP002
SITE ADDRESS: 11294 SW ELLSON LN ZONING: R -4.5
SUBDIVISION: BERG PARTITION LOT: 002 JURISDICTION: TIG
PROJECT: BERG PARTITION
Project Description: Sewer connection for new SF
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
DAVE & KAT BERG FEES
12210 SW ALBERTA ST Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 12/8/2008 $3,100.00
[SWINSP] Sewer Inspection Fee 12/8/2008 $35.00
Phone: 503 -710 -8365
Total $3,135.00
Contractor:
Contact #:
REQUIRED ITEMS AND REPORTS
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.
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Issued by _ /� Cam •ermittee Signature: 6 •"
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Call 503.639.4175 by 7:00 a.m. for an inspection that business da .
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.