Permit CITY T I GARD SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2004 -00275
��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/2004
SITE ADDRESS; 13743 SW LEAH TERR PARCEL: 2S109BA -09000
SUBDIVISION: DAFFODIL HILL ZONING: R -
BLOCK: LOT: 016 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
GOODLET /MARSHALL BLDG & DEV. CO.
PO BOX 91551 Description Date Amount
PORTLAND, OR 97219 [SWUSA] Swr Connectic 10/28/2004 $2,500.00
[SWUSA] Swr Connectic 10/28/2004 $0.00
Phone: 503- 297 -1881 [SWINSP] Sewer Inspeci 10/28/2004 $35.00
[ SWINSP] Sewer Inspeci 10/28/2004 $0.00
Contractor: -
Total $2,535.00
Phone:
Reg #: LIC 100882
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 - • a•ted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR • 2401-0100. You
ma y -ob •- copies -e these-rules -or- direct- questions -to- OUNC -by- calling- (503) - 246 -6•S9. – - —
/
Issu =d b / � P ermittee Si nature J�J �
Call (503) 6 • -4175 by 7:00 P.M. for an inspection needed e next business day