Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT# SWR2008 - 00161
TIGARD DATE ISSUED 12/9/2008
13125 SW Hall Blvd ,Tigard, OR 97223 503 639 4171 PARCEL. 2S103DC -00814
SITE ADDRESS 11345 SW FAIRHAVEN ST ZONING R -3 5
SUBDIVISION VIRGINIA ACRES NO 2 LOT 016 JURISDICTION TIC
PROJECT KLUMP
Project Description' Connecting existing 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
KENNETH & KLUMP FEES
11345 SW FAIRHAVEN ST 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 /;
Issued by j Permittee Signature ,7)//.' L1�J9ni
Call 503 639 4175 by 7 00 a m for an inspection that business day v
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