Permit CITY TIGARD SEWER CONNECTION PERMIT
l DEVELOPMENT SERVICES PERMIT #: SWR2006 -00149
All 13125 SW Hall Blvd., Tigard, OR 9 503 - 639 -4171 DATE ISSUED: 8/30/2006
PARCEL: 2S 111 AD -17700
SITE ADDRESS: 14786 SW JONAGOLD TERR ZONING: R - 4.5
SUBDIVISION: LADY APPLE LOT: 001 JURISDICTION: TIG
Project Description: Sewer connection
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
BEACON HOMES NW, INC.
12703 SW 67TH AVE Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 8/30/2006 $2,700.00
[SWINSP] Sewer Inspection Fee 8/30/2006 $35.00
Phone: 503 -570 -8828
Total $2,735.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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 Utilit Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may o n copies of the e rules or direct questions to OUNC by calling 503 - 246 -6. .a• 13 1 -800- -2344.
Iss ed by: N 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.