Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
� c DEVELOPMENT SERVICES PERMIT #: SWR2004 -00285
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/23/2004
SITE ADDRESS; 08071 SW LEISER LN PARCEL: 2S112BC-13800
SUBDIVISION: LEISER PARK ZONING: R -4.5
BLOCK: LOT: 007 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: Sewer connection for new SF detached dwelling.
Owner:
FEES
LEGEND HOMES
12755 SW 69TH AVE., #100 Description Date Amount
PORTLAND, OR 97223 [SWUSA] Swr Connectic 11/23/2004 $2,500.00
[SWUSA] Swr Connecti( 11/23/2004 $0.00
Phone: 503 620 - 8080 [SWINSP] Sewer Inspeci 11/23/2004 $35.00
[SWINSP] Sewer Inspeci 11/23/2004 $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 -• opted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throu ±h OAR 9'• 01 -0100. You
may obtain copies of_these rules_or_direct questions to_OUN ill
by calling (503) 24 • 699 -
Issued by: J� / �_,24-e a Permittee Signature: Ai
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day