Permit r
1
,; , ,_ �1 CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00201
TIGARD DATE ISSUED: 8/15/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102CC - 01800
SITE ADDRESS: 10255 SW HILLVIEW ST ZONING: R -3.5
• SUBDIVISION: FRELEON HEIGHTS NO.2 LOT: 021 JURISDICTION: TIG
PROJECT: HART
Project Description: Connect existing house to sewer service, septic tank is to be pumped and filled. Reimbursement
District #39 fee paid this date.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
VIRGINIA HART FEES
10255 SW HILLVIEW DRIVE Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 8/15/2007 $2,800.00
[SWINSP] Sewer Inspection Fee 8/15/2007 $35.00
Phone: 503- 620 -2964
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow
rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may
obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu d by: 1 1 1 ' . 1 P ermittee Signature: )(� afl
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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.