Permit C ITY OF TI GARD SEWER CONNECTION PERMIT
Ik DEVELOPMENT SERVICES PERMIT #: SWR2004 -00268
.�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/22/2004
SITE ADDRESS; 08015 SW LEISER LN PARCEL: 2SI 12BC -14200
SUBDIVISION: LEISER PARK ZONING: R - 4.5
BLOCK: LOT: 011 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 Description Date Amount
PORTLAND, OR 97223 [SWUSA] Swr Connectic 10/22/2004 $2,500.00
[SWUSA] Swr Connectic 10/22/2004 $0.00
Phone: 503 -598 -8900 [SWINSP] Sewer Inspect 10/22/2004 $35.00
[ SWINSP] Sewer Inspect 10/22/2004 $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 throug OAR 952 5 -0100. You
may obtain cosies of these -rules or- direct - questions to- OUNC -by calling (503) 246 •
Issued b ; , : A. Permittee Signature: NIP
•
Call (5 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day