Permit CITY TI GARD SEWER CONNECTION PERMIT
A fi I DEVELOPMENT SERVICES PERMIT #: SWR2004 -00313
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/29/2004
SITE ADDRESS; 14010 SW KARLEY CT PARCEL: 2S104BC -09200
SUBDIVISION: HILLSHIRE CREST ZONING: R -
BLOCK: LOT: 014 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: New sewer connection SF.
Owner: FEES
RIDGECREST CONSTRUCTION CO INC Description Date Amount
6600 SW 92ND AVE # 100
PORTLAND, OR 97223 [SWUSA] Swr Connectic 12/29/2004 $2,500.00
[SWUSA] Swr Connectic 12/29/2004 $0.00
Phone: 503- 246 -8808 [SWINSP] Sewer Inspect 12/29/2004 $35.00
[SWINSP] Sewer Inspect 12/29/2004 $0.00
Contractor:
Total $2,535.00
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"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules dopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through AR 52- 001 -0100. You
may obtain copies -of these rules -or direct questions -to- OUNC- b-- y- calling.(503) 24.6-66,,99..
Issued by: �j /� � � � Permittee Signature: y 1,0 /
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Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day