Permit CITY TIGARD SEWER CONNECTION PERMIT
e DEVELOPMENT SERVICES PERMIT #: SWR2006 -00067
,I. DATE ISSUED' 6/21/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL. 2S103BD -11500
SITE ADDRESS 11716 SW ERROL ST ZONING. R - 5
SUBDIVISION. CAPPOEN ESTATES LOT. 006 JURISDICTION: TIG
Project Description: New SF sewer connection
TENANT NAME:
CWS NO. FIXTURE UNITS.
CLASS OF WORK' NEW DWELLING UNITS: 1 0
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE LTPSWR IMPERV SURFACE:
Owner FEES
FOUR D CONSTRUCTION CO
PO BOX 1577 Description Date Amount
BEAVERTON, OR 97075
[SWUSA] Sewei Connection Fee 6/21/2006 $2,600 00
[SWINSP] Sewer Inspection Fee 6/21/2006 $35 00
Phone.
Total $2,635.00
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
Issued by: (e,tLR.ta, 13 L4 Permittee Signature: 0 m yl 1A ('u
I � Call 503- 639 -4175 by 7.00 a m for an inspection that business day.
I`
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