Permit C I TY OF T I GA R D SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00341
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2!4/2005
SITE ADDRESS; 13766 SW LEAH TERR PARCEL: 2S109BA -07500
SUBDIVISION: DAFFODIL HILL ZONING: R -
BLOCK: LOT: 001 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 SF sewer connection.
Owner: FEES
MARSHALL, GEORGE
PO BOX 91249 Description Date Amount
PORTLAND, OR 97291 [SWUSA] Swr Connectic 12/28/2004 $2,500.00
[SWUSA] Swr Connectic 12/28/2004 $0.00
Phone: 503- 705 -7933 [ SWINSP] Sewer Inspeci 12/28/2004 $35.00
[ SWINSP] Sewer Inspect 12/28/2004 $0.00
Contractor: Refund - [SWUSA] Swr 12/28/2004 - $2,500.00
Refund - [SWUSA] Swr 12/28/2004 $0.00
Refund - [ SWINSP] Sew 12/28/2004 - $35.00
Refund - [ SWINSP] Sew 12/28/2004 $0.00
[SWINSP] Sewer Inspect 2/4/2005 $35.00
Phone: [ SWINSP] Sewer Inspeci 2/4/2005 $0.00
[SWUSA] Swr Connectic 2/4/2005 $2,500.00
Reg #: LIC 159399 [SWUSA] Swr Connectic 2/4/2005 $0.00
Total $2,535.00
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 adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
- may - obtain - copies -of-these-rules-or-direct questions to OUN C -by -ca lling_(503)_ 2.46_6699.
Issued ( Permittee Signature:. )1i/ • .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day