Permit .A CITY OF TIGARD SEWER CONNECTION PERMIT
1 DEVELOPMENT SERVICES
PERMIT #: SWR2001 -00210
'�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/25/01
SITE ADDRESS; 10555 SW LADY MARION DR PARCEL: 2S110DA 07600
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 037 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer permit for new single family resident.
Owner: FEES
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST LINN, OR 97062 PRMT CTR 7/25/01 $2,300.00 27200100000
INSP CTR 7/25/01 $35.00 27200100000
Phone: 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 Ore tility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You -m - obtain- co. ies -of- these- rules_or_direct_ questions_ to_ OUNC_b_y_calling_(.503.)_ -9
Issue by: %ELI / D �� � Permittee Signature:
" � � -- -�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day