Permit f
CITY OF TIGARD
SEWER CONNECTION PERMIT
‘- COMMUNITY DEVELOPMENT Permit #: SWR2009 -00036
Date Issued: 06/01 /2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171 Parcel: 2S103DD00409
Jurisdiction: Tigard
Site address: 10965 SW FAIRHAVEN ST
Subdivision: Lot: 0
Project: Hansen
Project Description: Connect existing house to sewer service, approximately 160'. Septic tank is to be pumped and
filled Reimbursement District #38 fee paid
FEES
Owner:
HANSEN, LAURENCE LEE Description Date Amount
10965 SW FAIRHAVEN ST Sewer Connection Fee 06/01/2009 $3,100.00
TIGARD, OR 97223 Sewer Inspection - Residential 06/01/2009 $35 00
PHONE
Contractor:
PHONE'
FAX
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $3,135 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 law requires you to follow the rules adopted by the Oregon
Utility No ' - - . - -e -r Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100 You may copy of the rules
or dir- questions to OU 1 . by cal '.g 503.246 6699 or 1 800.332 2344.
I-sued By: ' _ Permittee Signature:
•
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.