Permit CITY TI GARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00269
'��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/13/2004
SITE ADDRESS; 07975 SW LEISER LN PARCEL: 2S112BD -LP013
SUBDIVISION: LEISER PARK ZONING: R - 4.5
BLOCK: LOT: 013 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
LEGEND HOMES
12755 SW 69TH AVE #100 Description Date Amount
PORTLAND, OR 97223 [SWUSA] Swr Connectic 10/13/2004 $2,500.00
[SWUSA] Swr Connectic 10/13/2004 $0.00
Phone: 503 -598 -8900 [SWINSP] Sewer Inspeci 10/13/2004 $35.00
[ SWINSP] Sewer Inspeci 10/13/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
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
a
may o pt of these- rules -or- direct - questions to -OUNC by- calling-(503) 246- 6699. - - - -- —
Issu by: CA_„,ti Perm ittee Signature , „i„,„4.,t, / / ��� /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day