Permit CITY TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00162
TIGARD 13125 SW Hall Blvd , Tigard, OR 97223 503.639.4171 DATE ISSUED• 12/9/2008
PARCEL. 2 S 103 D C -00822
SITE ADDRESS: 11310 SW FAIRHAVEN ST ZONING: R -3 5
SUBDIVISION. VIRGINIA ACRES NO 2 LOT 015 JURISDICTION: TIG
PROJECT CUMMINS
Project Description Connecting existin house to sewer, septic tank to be pumped and filled Reimbursement # 38 Fees
paid 12/09/08
TENANT NAME
CWS NO. FIXTURE UNITS
CLASS OF WORK' ALT DWELLING UNITS 1 0
TYPE OF USE: SF NO. OF BUILDINGS•
INSTALL TYPE IMPERV SURFACE
Owner FEES
ROBERT CUMMINS
11310 SW FAIRHAVEN Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 12/9/2008 $3,100 00
[SWINSP] Sewer Inspection Fee 12/9/2008 $35 00
Phone
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 p
Issued by: a Permittee S na ur' e �
Call 503 639 4175 by 7.00 a.m for an inspectionh at business day
This permit card shall be kept in a conspicuous place on the jol4%ite until completion of the project
Approved plans are required on the job site at the time of each inspection.