Permit CITY TIGARD SEWER CONNECTION PERMIT
x 4 440 ° DEVELOPMENT SERVICES PERMIT #: SWR2003 -00065
Alit DATE ISSUED: 2/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S102CB -07700
SITE ADDRESS; 13157 SW GRANT AVE
SUBDIVISION: POOLE MLP2001 - 00003 - ' ' ZONING: R - 4.5
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: S2AADti2 6.4n1t,1c_e7io r
Owner: FEES
POOLE, PHILIP & DARLENE Description Date Amount
13144 SW GRANT AVE
TIGARD, OR 97223 [SWUSA] Swr Connect 2/21/03 $2,300.00
[SWUSA] Swr Connect 2/21/03 $0.00
Phone: 503 670 - 8254 [SWINSP] Swr Inspect 2/21/03 $35.00
[ SWINSP] Swr Inspect 2/21/03 $0.00
Contractor: Total $2,335.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Issue C .,./.$ ' - i A • I ' Permittee Signature: ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busine s day