Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00157
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/3/03
SITE ADDRESS; 11515 SW HALL BLVD PARCEL: 1S135DA -01400
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: BRAHMAPREMANDANDA
USA NO: FIXTURE UNITS: 0
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 2.5 EDU increase for conversion of residence to ashram. Calc at Residential II rate, 1 EDU for first
5 bedrooms and 1 EDU for every 2 bedrooms after that. 10 bedrooms are 3.5 EDU's, 1 credit for
existing SF, difference is 2.5 ED's.
Owner:
FEES
BRAHMAPREMANANDA ASHRAM /TEMPLE Description Date Amount
11515 SW HALL BLVD
TIGARD, OR 97223 [SWUSA] Swr Connect 6/3/03 $5,850.00
[SWUSA] Swr Connect 6/3/03 $0.00
Phone: Refund - [SWUSA] Swr 6/3/03 - $100.00
Refund - [SWUSA] Swr 6/3/03 $0.00
Contractor:
Total $5,750.00
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 (r �L _ Permittee Signatu e:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day