Permit CITY TIGARD Rzzz ,,, SEWER CONNECTION PERMIT
l DEVELOPMENT SERVICES \ PERMIT #: SWR2000 - 00048
'= 13125 SW H all Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/28/00
SITE ADDRESS; 10599 SW LADY MARION DR MODEL \ PARCEL: 2S110DA - EH038
SUBDIVISION: BIZMIKSON HEIGHTS ZONING: R - 3.5
BLOCK: LOT: 038 JURISDICTION: TIG
TENANT NAME: RENAISSANCE CUSTOM HOMES
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for a new single family dwelling. MODEL HOME
Owner:
FEES
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97068 PRMT DEB 4/28/00 $2,300.00 0001773
INSP DEB 4/28/00 $35.00 0001773
Phone: 557 - 8000 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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 Ores . Utility 'tification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You -may obtain- copies- of -r-u s- or- direct - questions- to -OUNC— by-calling -(503) 246 -1 -987.
Issued � Permittee Signature:
Call (503) 63 -4175 by 7:00 P.M. for an inspection needed the next business day