Permit CITY OF TIGARD SEWER CONNECTION PERMIT
• '!7 n COMMUNITY DEVELOPMENT Permit# SWR2009 -00063
Date Issued 07/15/2009
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639 4171 parcel 2S103DC00819
Jurisdiction Tigard
Site address 11250 SW FAIRHAVEN ST
Subdivision Lot 0
Project Halderson
Project Description
Owner FEES
HALDORSON, LELAND K Description Date Amount
JEAN E, 11250 SW FAIRHAVEN Sewer Connection Fee 07/15/2009 $3,600 00
TIGARD, OR 97223 Sewer Inspection - Residential 07/15/2009 $35 00
PHONE
Contractor
PHONE
FAX
Type of Use
Class of Work
Install Type
Fixture Units
Number of Dwelling Units
Total $3,635 00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION Oregon taw requires you to follow the 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 a copy of the rules
or direct question is o OUN b�c (ling 503 246 6699 or 1 800 332 2344
C � k r�
Issued By P ermittee Si gnature `
Call 503 639 4175 by 7 00 a m for an inspection that business 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