Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00167
mirk' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/6/2004
SITE ADDRESS; 11440 SW ESAU PL PARCEL: 1S135CA -08600
SUBDIVISION: ESAU ESTATES ZONING: R - 12
BLOCK: LOT: 002 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
Owner: FEES
BARRY EDWARDS Description Date Amount
11695 SW NICOLAI PL
TIGARD, OR 97224 [SWINSP] Swr Inspect 5/6/2004 $35 00
[SWINSP] Swi Inspect 5/6/2004 $0 00
Phone: 503 -684 -0432 [SWUSA] Swr Connect 5/6/2004 $2,400 00
[SWUSA] Swr Connect 5/6/2004 $0 00
Contractor: Total $2,435.00
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
Ore tufty Nptification Center Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100 You
m y obtain copies of these rules or direct questions to OUNC by calling (503) 246-6.699
I sued by: Ill I I /t✓a_i__,,-, Permittee Signature —
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n t business day