Permit • CITY OF TIGARD SEWER CONNECTION PERMIT
A4' ;;i,' DEVELOPMENT SERVICES PERMIT #: SWR2002 -00238
.� DATE ISSUED: 9/20/02
s-`' "� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 10173 SW LADY MARION DR PARCEL: 2S111CB -03300
SUBDIVISION: MARION ESTATES ZONING: R -3.5
BLOCK: LOT: 006 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: Sewer connection for new S/F
Owner: FEES
MASTERPIECE CONSTRUCTION INC Type By Date Amount Receipt
15435 SW ASHLEY DR
TIGARD, OR 97224 PRMT CTR 9/20/02 $2,300.00 27200200000
INSP CTR 9/20/02 $35.00 27200200000
Phone: 503 - 524 -4371 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 throw h OAR 952 - 001 -0080.
You may obtain copies • hese rules or direct questions to OUNC by calling (503) 246 -1987.
I
Issued by: / 1 A d dA Permittee Signature: )-
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day'