Permit J
OF TIN y C ITY SEWER CONNECTION PERMIT
"I = DEVELOPMENT SERVICES PERMIT #: SWR2005 -00169
. ,��1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005
PARCEL: 2S 103CA -00201
SITE ADDRESS; 13235 SW HOWARD DR ZONING: R - 4.5
SUBDIVISION: WOODCREST NO.2 LOT: 015 JURISDICTION: TIG
Project Description: Connect existing residence to sewer lateral.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
MCGOFFIN, JAMES L + G M
13235 SW HOWARD DRIVE Description Date Amount
TIGARD, OR 97223 [SWINSP] Sewer Inspection Fee 6/2/2005 $35.00
[SWUSA] Swr Connection Fee 6/2/2005 $2,500.00
Phone: 503 - 590 - 9179 Total $2,535.00
Contractor:
�� g 9• REQUIRED ITEMS AND REPORTS
Phone: . CO) 1�`� C`cVO
Reg #: ���S��lit) �Q
®� A Y
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 -6:•99 or 1- 800 - 332 -2344.
Issued by1!�; • . _ Permittee Signatures "!.� - /
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that Ijusiness day.
This permit card shall be kept in a conspicuous place on the job Vte until completion of the project.
Approved plans are required on the job site at the time of each inspection.