Permit CITY TIGARD SEWER CONNECTION PERMIT
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��I�l DEVELOPMENT SERVICES DATE SSU 4/7/03003 00075 AO � !--- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 11455 SW GALLO AVE PARCEL: 1S134DC -12300
SUBDIVISION: CASCADIAN PLACE ZONING: R - 4.5
BLOCK: LOT: 012 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: Sewer connection for new SF detached dwelling.
Owner:
FEES
DON -HUNT CONSTRUCTION CO. Description Date Amount
P.O. BOX 1836
LAKE OSWEGO, OR 97035 [SWUSA] Swr Connect 4/7/03 $2,300.00
[SWUSA] Swr Connect 4/7/03 $0.00
Phone: 503 636 - 9912 [SWINSP] Swr Inspect 4/7/03 $35.00
[SWINSP] Swr Inspect 4/7/03 $0.00
Contractor:
Total $2,335.00
Phone:
Reg #:
Required Inspections
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: ✓�_ /� i „ %�jZ� Permittee Signature: ,Ark_
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day