Permit CITY TIGARD SEWER CONNECTION PERMIT
r . l DEVELOPME SERVICES PERMIT #: SWR2003 -00402
- -�1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/19/03
SITE ADDRESS; 11500 SW FONNER ST PARCEL: 2S103AC 02400
SUBDIVISION: ZONING: R - 4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect to sewer. Septic will be pumped and filled. Must be inspected and a pump receipt
received by COT
Owner: FEES
FILLER, DAVID E + MARY C
11500 SW FONNER ST Description Date Amount
PORTLAND, OR 97223 [SWUSA] Swr Connect 12/19/03 $2,400.00
[SWUSA] Swr Connect 12/19/03 $0.00
Phone: 503- 620 -1912 [SWINSP] Swr Inspect 12/19/03 $35.00
[SWINSP] Swr Inspect 12/19/03 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
Septic Tank Filled
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" Perm
Issued by: / Permittee
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day