Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #• SWR2008 -00163
TIGARD DATE ISSUED• 12/9/2008
13125 SW Hall Blvd , Tigard, OR 97223 503 639.4171 PARCEL 2S103DC -00817
SITE ADDRESS. 11225 SW FAIRHAVEN ST ZONING• R -3 5
SUBDIVISION• VIRGINIA ACRES NO 2 LOT• 019 JURISDICTION: TIG
PROJECT: BURMAN
Project Description. Connect existing house to sewer service Reimbursement District #38 fee paid
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.
RAY & JUDY BURMAN FEES
11225 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223
[SWUSAJ Sewer Connection Fee 12/9/2008 $2,600 00
[S WUSA] Sewer Connection Fee 12/9/2008 $500 00
Phone. 503- 639 -0134 [SWINSP] Sewer Inspection Fee 12/9/2008 $35 00
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
Issued czapc 4 Permittee Signature: 1 4 : 46,6w/r
Call 503.639.4175 by 7:00 a m. for an inspection tha .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.