Permit CITY T I G A R D SEWER CONNECTION PERMIT
AK DEVELOPMENT SERVICES PERMIT #: SWR2004 -00304
All DATE ISSUED: 12/2/2004
13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 08089 SW LEISER LN PARCEL: 2S1126C -13600
SUBDIVISION: LEISER PARK ZONING: R -4.5
BLOCK: LOT: 005 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
Owner: FEES
LEGEND HOMES Description Date Amount
12755 SW 69TH AVE SUITE 100
PORTLAND, OR 97223 [SWUSA] Swr Connecti( 12/2/2004 $2,500.00
[SWUSA] Swr Connectk 12/2/2004 $0.00
Phone: 503- 620 -8080 [SWINSP] Sewer Inspeci 12/2/2004 $35.00
[ SWINSP] Sewer Inspeci 12/2/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #: LIC 60563
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 thro gh OAR\s 001 -0100. You
may obtain ' s of these rules or-direct- questions to-OUNC-by-calling (503) -24. -6699. `
Issued by: J; ��4�t Permittee Signature: ,, a,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day N