Permit CITY TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2009 -00005
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639 4171 DATE ISSUED: 2/2/2009
PARCEL: 2S 103DC -00815
SITE ADDRESS. 11305 SW FAIRHAVEN ST ZONING' R -3 5
SUBDIVISION• VIRGINIA ACRES NO 2 LOT. 017 JURISDICTION. TIC
PROJECT: ADKINS
Project Description: Connect to sewer
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:
ADKINS, KATHRYN J TR FEES
11305 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 2/2/2009 $3,100 00
[SWINSP] Sewer Inspection Fee 2/2/2009 $35 00
Phone:
Total $3,135.00
Contractor:
LOVETT EXCAVATING INC
PO BOX 86280
PORTLAND, OR 97286
REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -504 -2847
FAX 503- 288 -1630
Reg #: LIC 125507
PLM 26 -773PB
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. ��`��J"` (°9 c,,,,A Q L-411@ki Permittee Signature 0 ' pQlt (�
Call 503.639.4175 by 7:00 a m. for an inspection that business day. 1`, - �
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.